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$13- t;it ot �e h rnnis rire <br /> Y P Y fax-s�e-isu-uul� <br /> Permit Application <br /> Date Received � �� Phone Contact for Permit <br /> �s�' . ... � v � � <br /> Owner's Name ( G � �� � � <br /> Owner's Phone Number <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� <br /> Fee Simple Titleholder Address <br /> � - " . .:.r .i�Bs4+3°' ��', ab`:.:d;��`. _..�,L;_ - _ . ' - - - - <br /> - _:rt:��€s4.�'�'C4�"��.�a «�.>.m'A�"�t"zTxFf^8c_ _ ° � », <br /> Job Address �j� E Vu 1r c.� �Y Lot # � <br /> Sub Division Paroel # <br /> a t �. .< m..�,a:�� ��• . . �''����_����� : �. „ - . <br /> ` - .: . _ . , . .. _ - il�ae�.:*�:_ .,,, �7»p:,, ._ ��lm _ 'C�.s�.�ne�caa:, ,s�.�....r.+tx �r;,.r..s:,^_M: a.',�> �..r <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-Instaltation <br /> � Emerge�cy Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> ❑ � emi � er ❑ <br /> Sprinkler ❑ O ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � q ❑ p C� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> Z , >f'v�F" ...., n . .,..y.�:.0 re.�-. ..°YtYr_'�""':.'"as:o.?'."�_ eo_: -,�s i .. <br /> ° . .. .. , Q: ::.X'�"9cT -� - t_ r:" '+«l,,� `Y'XA�++^:'.xz>c=�� �' @�..- .v ,�,_ Y,rv ....: � : 'T!:S..roL" t!, 4FF'r; e, <br /> Contractor �� � Company � <br /> Signature Lq ✓ 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 Mro (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcei #- obtained from Property Tax Notice (hrip://appraiser.pascogov.com) <br />