Laserfiche WebLink
a�s-��o-oozo �ityor�epnyrnius rire �ra�-s�e-��o-ouz� <br /> Permit Application � <br /> Date Received Phone Contact for Permit r� � <br /> �. . _. .. ,t .., . . _ .. <br /> Owner's Name � Owner's Phone Number � � � <br /> Owner's Address u g�V � r N� �( <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> 4 _ _ .:E�� - .^i�a�."°� - ,s��. :�.MS.°"w'�-;v��... „3 .:c� _°.�.�«., 1r=5�:'>__ a:�.+�.,^�< _ • <br /> Job Address Lot# � <br /> Sub Division ' Parcel# <br /> e ee-. , � ..:�.-ea.. ,, .�.aa:« _ -- - ..,,.;-�=k���:s:�aa:a�.�s:�,�«-r,.��w^.e°a��-T� . ... - - _.�s�-.�citr .r_<.>.. _,.se�r.m�?e;�,,.�s,.wra-:=,�:,:��,,.�,t^ture�a�v�.,, ,,v��a�n:w .;,y :;.Wa�r <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Materiai(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 /> �y emi �n er �V <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Burn �2.ei <br /> Fire Alarm � ❑ ❑ ❑ � � Sparlclers ����f�"' ��/✓) <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations �1 ' � <br /> -.--Hood-S ion � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) N �� <br /> �._.. � 3� <br /> Fire Alarm Installation � Torch Roofing/Tar Kettle ��� <br /> Fire Pumps � Waste Tire Storage ANNUAL � <br /> � Fire Works <br /> � Flammable Application-ANNUAL L �f Valuation of Project <br /> � Fuel Tanks <br /> ��Other: ` � 'S � a r <br /> � t'",d3�a:Mr.a ;re. , x w.v . 59' `-_:;::�� _�°4,R£'-,Y".s'�:-at3'�.::'ke�..�a5k;�tfit'fi:'d-...,,q;-y.�.._;r ar.. ,�r. nn+�.m�,yr�4 e-r "xi.�- � ._ � . ,.�_ ... .. . " „s_� , " <br /> v:�.s+ , <br /> Contractor � Company y {�- j q r q/� � <br /> Signature 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 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 submittal date. Parcel#-obtained from Property Tax Notice(hrip://appraiser.pascogov.com) <br />