Laserfiche WebLink
u��-��v-w�v l�ltY VI LC�JIIyIIIIIIJ nio rax-oio-�ov-vuci <br /> Permit Application <br /> Date Received �? � 2-`� 1 �- <br /> Phone Contact for Permit `� � � `7�! +� �� <br /> e .. . �-- _- .�..,.... . . ,. _ . _.,.,�. _ ,. > . ,;� .. _ � ,. ._�_�.� <br /> Owner's Name ' �n�n S �j j�CZ Owner's Phone Number ��I 3 ��Z y 2-7'Z <br /> Owner's Address �c �o ��- �-'�-'��� ��fC� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � � <br /> Fee Simple Titleholder Address <br /> i� ._ - ., ;..����^:�:�.:�s�:�:. _ _ �i...���s�+: s.�w,'� °a,:�,.3'� <br /> rN�roz.°:8"# °.�A��'4.'- <br /> Job Address �j�.�-- � �� <br /> Lot# <br /> Sub Division Parcel# <br /> R ��_�� aaa�v.n'r.�;��.�,�<y:-,. - - - - . .- . - ��°`°''g�""K,=- <br /> - - - - _°".�'s.�� -- 'k'�,= _ .. nr <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood�nstallation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation � <br /> � Emergency Generator>30 kw � LPlNatural Gas-ANNUAL Sale �' 2� 3 <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ B � Recreational Bum <br /> Fire A�arm � ❑ ❑ ❑ � � Spa�lclers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression /❑ ❑ � ❑ � � Standpipes(Sprinkler Sys) <br /> QFire Alarm�nstallation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> aFire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> y � _ .�„t "�vL�E�a�Gi#i+"4=:.�1i., '�ar -^4r�•i . �,-°'ms°'�:�°.i^`MS-^."_��5t1�v1'rd°ASEX'. . _ . _ & . , <br /> Contractor �,,..—�__.,�..7.� — Company F,�L �;° ��t{j �,7�. <br /> Signature ,- --',,/C� <br /> Registered Y/N Fee Current Y/N <br /> Address pp O,t' �y�g L�,�d O C.4,� �i 3yG.� License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> 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(;ument Y/N <br /> Address License# <br /> OTHER <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> s <br /> Directions. <br /> Fill out application completely <br /> Owner 8 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 submittai date. Parcel#-obtained from Property Tax Notice(http.//appraiser.pascogov.com) <br />