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��:r�nu-uuzu c;ity ot cepnyrnuis rtre rax-n�,i-iau-uu�1
<br /> Permit Application
<br /> Date Racetved for P
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<br /> Phone Contact ermit
<br /> Owner's Name O�vners Phone Numher �� � �
<br /> Ownars Address � �
<br /> Fee Simple THleholder Nama 71Ueholder Phone Number � � �
<br /> Fee Simple TiUaholder Address
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<br /> Jo6 Address � �
<br /> Sub Oivisian Parcel�
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<br /> � Bfo-Hazarcl Waste Storage-ANNUAL � Fuml aGon Tent
<br /> � Comm ExhausE Kitchan HoodlDuct Q Nazardous Material(Tier[I or RQ Faalily)ANNUAt
<br /> � Controlled Burn Q Nood{nslalladon
<br /> QEmergency Generator<3U kw a lPllJatural Oas-InstallaUon
<br /> aEmergency Generator>30 kw � IP/Naturai Gas-ANNUAL 3ale
<br /> � fire Ptotectiort Mafntenance-ANNUAL � Places of Assembty-ANNUAL ��
<br /> �y em � er �r�
<br /> Spdnkler � Cl ❑ O B � RecreaUonal Surrt �
<br /> Fire Alarm � Q ❑ Q� � � Sparlciers
<br /> Hood Cleaning ❑ ❑ C} � � Sprinkler System Installations
<br /> Hood Suppression � ❑ � Q � � Standpipes(Sprinkler Sys)
<br /> aFire Alarm instailaGon � Torch Roofinglfar KetUe
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Ffre Works
<br /> n Flammable Applicatiort-ANNUAI. � ValUaflOi�Of PfOjeCl
<br /> �—�
<br /> U Fue!7anks
<br /> [] Other:
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<br /> Contractor C9mparty
<br /> S3gnature Regislered /N fee CuRant Y/N
<br /> Address Ltoense#
<br /> EtECTRiCIAN , Company
<br /> 5tgnature tte�is�ered Y/N Fee Curcent Y/N
<br /> Address Ltcense#
<br /> PLUMBER Company
<br /> StBnature Registered Y/N �e8 Current Y 1 N
<br /> Address Ltcense# �— �
<br /> M�CHAN[CAL Company
<br /> Signature Registered Y/N Fea Current Y/N
<br /> Address Ucense#
<br /> OTH�R Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> �d�� Licenae#
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<br /> Directions:
<br /> Fill out appflcaUon compfelety.
<br /> Owner&Contractor sign back of applicallon,notadzed(Or,copy of sl�ned conlract with rnvner)
<br /> if over$250Q,a 1�[Wtos of Commencement is iequired{Mechanical work ovar�5000)
<br /> Suppiy hvo(2j sets of dra�vfngs wilF►applicabte documentetion
<br /> Alfow 10-14 days for review aRer submiEfal date. Parcel#-obiained trom Property Tax NoUce(hUp:!/appraiser.pascogov.com)
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