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� V V ""y "'���"y��,"� ' "c rax-ts 15-780-0021 <br /> Permit Application <br /> Date Received "G� � Phone Contact fo�r�NPermii �'l�j ��7� ��� <br /> � � ���� <br /> OHmers Name r—� �� '�� <br /> Qwners Phane Number L�J <br /> Owners Address <br /> Fee Simple Titleholder Name Titleholder Phone Number [� � I � <br /> Fee Simple TiUeholder Address L'-- <br /> ;�"s'__=_-_ --—'�=�%w�"'�-..,'?���.���,�`•-'�'�w_�,. <br /> Job Address �L/ ��� �c.�� �/V /�j <br /> 'S �oc# �� <br /> Sub Division Parcel# <br /> -�._ --•�� <br /> ^ �...�---�°-�°�'"-�''� �r�.«�'���.°�.,��_ >�-_�-�.•••��_��-�:�„.�: <br /> aBio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Materiai(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum a Hood Installation <br /> aEmergency Generator<30 kw a LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw a �P/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL a Places of Assembly-ANNUAL <br /> ❑(LE r y emi �n er <br /> Sprinkler ❑ ❑ ❑ � a Recreational Bum `i <br /> Fire Alarm � � ❑ ❑ � � Spariclers � (��`�� <br /> Hood Cleaning � ❑ ❑ p � � Sprinkler System Installat�ons <br /> Hood Suppression � r p y ❑ � a Standpipes(Sprinkier Sys) <br /> a �' o <br /> Fire Alarm Installation Torch Roofing(Tar Kettle <br /> QFire Pumps � Waste Tire Storage ANNUAL <br /> aFire Works <br /> � Flammable Application-ANNUAL . Valuation of Project <br /> aFuel Tanks <br /> Q Other: <br /> Contractor �- <br /> Company m G - � /a--���.��.i <br /> Signature Registered Y/N Fee Current Y/N <br /> Address y"7�/ L"iG. �-4r r- C�'' -'� ( Lice�se# <br /> ELECTRICIAN � /Y�3�1 �o�j�.��'f <br /> Company <br /> Signature Registered Y/N Fee CuRent �'/N <br /> Add�ess 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 � <br /> License# <br /> OTHER <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> Directions: - <br /> Fill out appiication completely. <br /> Owner&Contractor sign 6ack of application,notarized(Or,copy of signed cont2ct with owner) <br /> tf over$2500,a Notice of Commencement is required(Mechanical worlc over$5000) <br /> Supply two(2)sets of drawings with applicable docume�Yation <br /> Allow 10-14 days for review after submittal date. Parcel#-obiained from Property Tax Notice(httpJ/appraiser.pascogov.com) <br /> ��,�, �,3_ t� i-��ga . <br />