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s� 3-�so-oo2c t; ity ot �epnyrnuis r ire rax s tsu <br /> ` Permit Application <br /> Date Received 7„ t ( � <br /> . Phone Contact for Permit , Q ._ �' <br /> E T. � � <br /> Owner's Name ��/� �jr✓ s Owner's Phone Number ��� �� <br /> Owner's Address 79,s ��� ��/ � " � / 33�`f� <br /> Fee Simpte Titleholder Name Titleholder Phone Number �� �� <br /> Fee Simple Titleholder Address <br /> B 4�a;4:..�.,..� '%6;�s:".4'S"Fr^.�'!`v`�=a "2i; r,Yd.°:'�:�* _"$, _ _ . �s.3+ - - _ <br /> n�� . z �:P- __ _ ' . -'±'�H„'?RP�'�:°� <br /> Job Address � Lot # �� <br /> Sub Division Parcel # <br /> e , :.,.r� ,.,, g > 2a,,. , _ .. -- - - <ti>�-� -.erc°�e�t:�..,:�a , -_ _ �r;�-_ . .'��x - - <br /> � - '' - - _ _ ..'�':.e�ax. �o^��a:�s <br /> � Bio-Hazard Waste Storage -ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> r y emi �n er ❑ <br /> Sprinkler � ❑ ❑ ❑ Recreational Burn � <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers � ./ � <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations / f��j � �' <br /> Hood Suppression � ❑ � ❑ � � Standpipes (Sprinkler Sys) %' ` <br /> � Fire Alarm Installation � Toroh Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL '�---- <br /> � Fire Works <br /> a Flammable Application- ANNUAL Valuation of Project <br /> a Fuel Tanks <br /> Q Other: <br /> b ' ^.e'qk�n�$#`:.�+W%�+;�14• a:s,ti q;:o -r : ..g�:'�.�it€SK�+9k'aiK'_ "s'rt`.�<M13.�a_3?kC ,. , s �$°"'8�R£`4'+�`.":Pa'r,• + y.• - r' rc ;'�4� , �d ^ `im`Tc',+.." ^ S'.E..b:s84+fstr - .�s' - ;d :,°"u'+�*R�iM?f"�.'� '.Yd�'rr `. <br /> Contractor Company � <br /> Signature Registered Y/ N ee Current Y/ N <br /> Address /t License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> � License # <br /> Directions: <br /> Fill out application completely <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />