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<br /> _ Permit Application
<br /> Date Recelved Phone Contacl for Permit
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<br /> Owner's Name er's Phone Number � � �j
<br /> Owners Address . �
<br /> Fae Simple Titleholder Nama TiUeholder Phone Number �� � �
<br /> Fee Sfmple TiUaholder Address
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<br /> Job Address � �}.��1 (,, ��� I.ot# ' �
<br /> Sub Diviston Parcel#
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<br /> � Blo-Nazard Waste Stora�a-ANNUAL � Fumlgatlon Tent
<br /> a Comm E�chaust Kitchen FtoodlDucl � Hazarcfous Matedal(Tiar!I or RQ Facility)ANtJUAI
<br /> a Controlled Bum � Hood Inslallatlon
<br /> � Emergancy Generator<30 kw Q lP/Natural Gas-lnstellation
<br /> � Emergency Generator>30 kw � LPNVatural Gas-ANNUAL 3ale
<br /> � flre Protectlon Malntenance-ANNUAI � Placea of Assembly-ANNUAI.
<br /> � em � er
<br /> Sprinkier � O O 64 � Recrealional Bum ��/
<br /> �FEre Alarm � ❑ O Q � � Spa�klers
<br /> Hood Cleaning � ❑ ❑ o � � Sprinkter System installaUons
<br /> Hood Suppression � D ❑ ❑ � � Standpipes(Sprinkier Sys}
<br /> � F!re Alann Installatlon � Torch RoofinglTar Kettie
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Ffre Works
<br /> � Flammahle Applicatlort-ANNUAL Valuaiion of Project
<br /> Fuel Tanks
<br /> Q Other:
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<br /> Contracior ��� (� Company ` � nj'y'�,
<br /> Signalure �11-1C-JL�.N Regtstered Y/N Fee Current Y/N
<br /> Address ` (p l.(cense it
<br /> ELECTRICfAN Company
<br /> 5ignature Registered Y 1 N Fee Cunent Y/1�!
<br /> Address Ucense#
<br /> PLUMBER Company
<br /> Stgnature Registered Y/N Fee Curcent Y/N
<br /> Address �icense#
<br /> MECFUW ICAL Company
<br /> Sfgnature Reeistared Y 1 N Fee Current Y!N
<br /> Address l.icense#
<br /> OTHER Company
<br /> Slgnature Re9tscerea Y!N Fee Current Y!N
<br /> Address License#
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<br /> Dfrectlons: ,
<br /> Fili out applicatfon comptetely.
<br /> Owner&Contractor sign back of spplication,notarized{Or,copy of slgned conVact with rnmer)
<br /> I(over$2500,a IJoUce of Commencemant fs required(Mechanfcal work over$5000)
<br /> Supply hvo(2)sets of drawings with applicab�e docume�tation
<br /> AI[ow 10-1A days for revtew after submittal date. Parcel#-obtairsed from Property Tax NoUce�http://appraiser.pascogov.com)
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