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•13-780-OOZU c;ity or�epnymms rire Fax-81 d-/SU-UUY1 <br /> Permit Application <br /> Date Received Phone Contact for Permit � �, <br /> P" ' _".. .Y,�_. :SM�a:.#rm�Mr�._ .��� . . , ir r)rsw.�t.M'c�`.+.`ae'+YRq,,,�•.i s;^'pw+F�w" . <br /> Owners Name � �� Owner's Phone Number � C� � C� <br /> Owner's Address p�- `V <br /> Fee Simple Titleholder Name Titleholder Phone Number � �� � <br /> Fee Simple Titleholder Address <br />� _ :� _.,,��. �s����r -^:u:�s�-�<�-��.:�. � , :�*.�.�. ,x* - <br /> — - �' <br /> JobAddress �� ` � `✓'U� C �KIr����� ro Lot# � <br /> Sub Division Parcel# <br />� ,:�e.,�-�� .�-��.��.^� _ - , ._� . �>.:_�. _ qa.��..:���� � .<�:�..-:..-e�.,,;;� ... .�.m <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generato�>30 kw � LP/Natural Gas-ANNUAL Sal�% � <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANN � �/ <br /> �y emi �n er G� �� <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum ,/,� � <br /> Fire Alartn ❑ ❑ ❑ Sparklers � <br /> � � � <br /> Hood Cleaning � � ❑ ❑ � � Sprinkler System Installations _______,__,,,..-- <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation a Toroh 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 /> e� W-?��.�?4e:r" , �. s. !s.-�b� . :�:.;s,.:3 - . - �'c'.a...,..:�..c,�.,,. �.._ , rx:, .. .' „'�.:.-�res^�. .- , -mt2,x<.'�-r._-tt•,,9.. . ""r��a� �.. ,. .- .. , .,, <br /> Contractor ' Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address �?✓�, 5C License# <br /> ELECTRICIA 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 Current Y/N <br /> Address License# <br /> OTHER 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 documentation <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />