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v�ar v��cN�iy�iuuo i i�c rax-�l,5-780-0021 <br /> Permit Appfication <br /> Date Received �-a� -aor� [ � 3 C�� .�C� <br /> +�r�nnit ,s.,, �„ _-- Phone Coniact for Permit � [ <br /> -�..�...,� �� ..�. �-__�,a,a,� _�— � � <br /> r.� � <br /> ers Name Owners Phone Number �—J �� �� <br /> Owners Address <br /> Fee Simple Titleholder Name Titleholder Phone Number [� � �� <br /> Fee Simple TiUeholder Address �--�J <br /> 'e_a"cq'aaw'mjnsx'.a�'E — �p.�- � � ��'r'`-�.�'��'r`,.`^u'�'"�� "'�,�.�%��,4'��'k�'��,.�,*.53�a�t.� <br /> 7d�� �� 1 / - �� <br /> Job Address �. �K��1�� ���� �,��p�Y� Lot# <br /> Sub Division � <br /> � ��� Parcei# <br /> ��z�xg s��-���.,.�_�._...��,��__ <br /> a --�.�.�.r�a=�".�a�,::� '�'a` zt�.�-.--���5.t;.`� , <br /> Bio-Hazard Waste Storage-ANNUAL a � <br /> � Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct a Hazardous Mate�al(Tier II or RQ Facility)ANNUAL <br /> aControlled Bum Hood i�stallation <br /> aEmergency Generator<30 kw � LP/Natural Gas-Installation <br /> a Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � <br /> Places of Assembly-ANNUAL » <br /> ❑ r y emi �n � � � <br /> Sprinkler �,�� � � <br /> � � � Recreational8um � �J� <br /> Fire Alartn ❑ � � � (�—� � � / "/ <br /> ❑ Sparklers <br /> Hood Cleaning p ❑ p � � Sp�nkler System Inst Ilatio�s (' <br /> Hood Suppression �t � X � (��I � <br /> aLJ Standpipes(Sprinkler Sy y <br /> Fire Alarm Installation a Torch Roofing/Tar Ketlle <br /> a Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL <br /> aValuation of Project <br /> Fuel Tanks <br /> Q Other. ��, d � � sf r. <br /> Co�tractor <br /> Signature / Company Y1'� � _ � � ,.������ <br /> Address Registered Y/N Fee Current Y/N <br /> �J?o/ �G ��r C,.•- <br /> ELECTRICIAN T' � License# � �Y�3�z 1�oc�f�.��� <br /> Signature Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# � <br /> PLUMBER <br /> Signature Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> MECHANICAL <br /> Signature Company <br /> Registered Y/N Fee C;urrent Y/N <br /> Address <br /> License# <br /> OTHER � <br /> Signature Company <br /> Registered Y/N Fee Current Y/(� <br /> Address <br /> Oirections: License# <br /> Fill out applica6on completely <br /> Owner&Contractor sign back of application,notarized(O�,copy of sig�ed contract with owner) <br /> ff over$2500,a Notice of Commencement is required(Mechanical work over$5p00) <br /> Supply two(2)sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained frvm Property Tax Notice h J/a raiser.pascogov.com) <br /> � � ttP' PP <br />