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ais-��o-oozo c,ity or�epnyrnuis rire hax-81d-/8U-UU21 <br /> � Permit Application <br /> Date Received �OR Ozli2.2-//Z Phone Contactfor Permit c� 3 rt �_ 935� <br /> E <br /> Owner's Name � ,2�O f f Q�(��}��t Owner's Phone Number ��3 —�7 9'3.� <br /> Owner's Address � 0 ��X �7�l� T���'�� -�� 33 67y� <br /> Fee Simple Titleholder Name Titleholder Phone Number � C� � <br /> Fee Simple Titleholder Address �� <br /> � - .0 ..e.��s:.� ., > .z�..,...., �.. <br /> - °;?�E',`��:..�..:.-„w�.�°'f�'T�,x�,4�'--:ai„. - <br /> - - `:s+"3'^c:'."-a':s.-�,. ° "�7�6.`t3.'�',+":xir�i'__._—__ _ ` ,::'-c"�=�.i%;: <br /> Job Address ���Tj-�i�piOX C�} � �Q� G,�L L ��--�,/D Lot# � <br /> Sub Division <br /> Parcel# <br /> k " zY. �� .,.�s<�'�R_ _ _ - �r�.�:� --'.z�.f�:::'a�9�t.4_�.,�a�e ,. -� - <br /> _ _ . .:.._*_«��fi.=�..�..�an,aae::.;.z. . `s'�±&;".' . ,_ �5€�r.�,,.0.r.,:r.�:x�.�:�r <br /> � Bio-Hazard Waste Storage-ANNUAL a Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum a Hood Installation <br /> � Emergency Generator<30 kw a LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> ❑� emi � er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum 2 <br /> Fire Alarm � ❑ ❑ ❑ �� � Sparklers ��J J <br /> Hood Cleaning �p � ❑ � � Sprinkler System Installations �� <br /> Hood Suppression � ❑ ❑ O �� � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation a Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> aFuel Tanks <br /> Q Other: <br /> w ���:�.a ;.x�.�� -_.�:�>�:�-. �,�.��:�s.,d ���•� <br /> p��.,���+.���n:�--�._ .,. �.r...� .�:���,-.�����«,��:-��-��:8:.,..•�-.���..;�-�,.,.=.K <br /> Contractor h' ` �t ��` ��`"'°�°°' <br /> � � Company <br /> Signature c>%"�' � <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> PLUMBER <br />�:_.,_..._„ Company <br /> ��� Registered Y/N Fee CurreM Y/N <br /> MECHANICAL ------ --��_ <br /> Signature Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> OTHER <br /> Signature Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> Directions: License# <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 submittai date. Parcel#-obtained from Property Tax Notice htt //a <br /> ( p: ppraiser.pascogov.com) <br />