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<br /> Permit Application
<br /> Date Received � Phone Contact for Permit
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<br /> , v� Y( �V Owner's Phone Numb r � � �
<br /> Owner's Name � � (
<br /> Owner's Address � �� 1 � D��� L/V V ��/
<br /> .
<br /> Fee Simple r Name Titleholder Phone Number y
<br /> Fee Simple Titleholder Addre
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<br /> Job Address � � Lot# �
<br /> Sub Division Parcel#
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<br /> 4� 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 �f� –�� /� o��
<br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation /�Q������l
<br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale y � ,�f��
<br /> � Fire Protection Maintenance-ANNUAL � Pl.acesnf. ssembly-ANNUAL ���
<br /> �
<br /> ❑ ry emi �n er r..- : -_T�) �1�>/.Getk r7'� S -
<br /> Sprinkler ❑ ❑ ❑ Recreational B ��i/�
<br /> Fire Alarm � ❑ ❑ ❑ � Sparklers
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations ' ����
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) �
<br /> � Fire Alarm Instailation � 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 /> Q Other:
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<br /> Contractor � Company � �
<br /> Signature ^ � • � Y�� Registered Y/N Fee Current Y/N
<br /> Address M 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 Cunent 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)
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