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a�saao-oozo �iry or �epnyrnws r�re �aX-��3-�au-uuz� <br /> Permit Application <br /> Date Received �� ��1 '�.O l� Phone Contact for Permit �� 3 Glo � 0�' � <br /> , � �� _-� _,., �.. .- . <br /> Owner's Name �' � p.^ ;�, �'O ' P 1 �.- Owner's Phone Number �� � <br /> Owner's Address �7 C�Sc� G7 /a.�..� �l.-V (� - 3 3S`'� � <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> ,.. ..a... •r;�:.rr:; �,�° �:,aa.;.r_... ,;.,�� o, r..a» �:r�a�r...:a�. ��2=;��,s:=n�,,.� - . - .. ;.� <br /> [ Job Address � d S d �µ � �'' �--L g �- v � � � 3 � � � Lot # � <br /> Sub Division Parcel # <br /> f �W -.F. �.ns3$a'v�`�". _'.'�!kY^I '.o-RSe_�A�; -. -.ch'Sr�r� , „ „ �.H,k.�. , � , ks.R.�k';'.�y'$YS#�.4�t•t;,`.�3`A'.'S1 1 d.l0 � , _$?F.3�"'�-$:`SSYAF�"i4'�3�lNR"ah.+� .s�n'-y+rtb.k'aw. ,e'n�.n <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier 11 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 /> �y emi �n er � <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum p �'�L �.Y� <br /> �.... �� � r2�3� <br /> Fire Alarm � ❑ ❑ O � � Sparklers (),/� „ <br /> Hood Cleaning � ❑ O ❑� � Sprinkler System Installations �„"• <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> � Other: r�RZ 4'R.t+�6c: f►-C�ovr�� �csv� M�� <br /> s �. .., .-a..a� ..�. x�: �..t&� w��'�«�s°- -�r,�s:.�...,� _ .. .�... , .. -i?•Ra.�rr:--° ;;":.r..i _..&ssar°;.. <br /> - - 6�`�^5� ,T+�-.."rh <br /> ContraeinC_ , Company S �Vl PL ' k��2 /�v rv 4 L L <br /> Signature c Registered Y/ N Fee Current Y/ N <br /> Address 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 License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address 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 />