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aisaso-oozo t,ityot�ephyrnuis rire fax-81d-/8U-UU21 <br /> Permit Application <br /> Date Received ; ^ S'�j--o�G i� Phone Contact for Permit �� �CC�7 �0��._, <br /> . ,. . . _„ .. .� . - ' _ s. .-.� � <br /> Owner's Name t"1 O J'�i d�'`� V'S P� `G-\ Owner's Phone Number CU �� 7 C�� l�I 8 <br /> Owner'sAddress 7�.5 �7 C?A'�-�- ��-I/`� Zl-(��-k�'(L-�II-LS <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> i _ _ _ _ ,A'°"' 'w u'.-. �d.5:3'.'K�-�«`�.`t'.'��4=`wF-i_ � v'..E%rv:,;.{�'a�'�:n�.�'; .}.'..Y�.'�'a�w`�..�.�'��5�."'.+'.�Y�yl�.''ff�; � _'_ - �v�+'.`%�3a4.�. <br /> �iT: <br /> JobAddress �'oS 0 G� AL�- 3G�� Z� P�Y/L-J-�I (�(,S �_� � �ot# � <br /> Sub Division Parcel# <br /> p �r ;<�,�..�«. . y'Mrz4:h'"s#a2.�'TS'+s�+�iYR��ri.�+'=:?'�i"n;lt�,a�.2e�7?�x.�-���.a���s.:r�7�,!�.:r,�p ._ as�. � i"t�� "a�°�.rw�a�we <br /> .�,g:.��.,s��.'EnX;da.���:.:ts':+t�' ,_ _ _ ' .bd�•a�F�ik'#'��.'�3' . , ..-��:�:- . �. <br /> � Bio-Hazarcl Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn a Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installatio� <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sate <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL ��/ <br /> �y emi �n er � �n <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum �f <br /> p <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � 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 /> Q Other: <br /> t- '*LXSri��;.- �r,:t.a�-�4^ ,-�.u.;n*T':�-,+w-J:�:at��,. ;�'a..�m�,3#!'�.A.z�=�Sam'.m°'�^,�:�?�'=�^esi.:a°s°,?_::'"xx.�';;. n-sw -°�-��a��r,•b -. =�s»r <br /> A<3.e^���7`�st7'z�+p�'�'ri:,: , 84s�S.;,�,p.:�.,«-etsaT.ta.°'�4�h�.s�'1G`.: <br /> Contractor �.f- Company S{{�I�Q(,�;7C 2!�)Vl <br /> Signature Registered Y/N Fee Curtent 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 Cu►rent Y/N <br /> Address License# <br /> OTHER <br /> 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 documentatio� <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) - <br />