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s��-�so-oo2o c:ny ot tepnym�iis rire FaX-s��-�so-oo2�
<br /> , , . Permit Application
<br /> Date Received � . ,. ,. ``_, Phone Contact for Perrr►it � � �
<br /> Owners Name ' Ownars Phone Number �3 ' `/j� (rc�
<br /> o�,er$nda�s 3a c,c,l �1 rn��i Is � 335�
<br /> Fee Simple Titleholder Name Titleholder Phone Numbar � � �
<br /> Fee Simple Tideholder Address
<br /> . . • ,er�c� 'n. '.-i a-a:.,:;f'^.T"tw{CM1Yi;r; ..�:r,'• .-v ..�t. ...�.c�. .q,<.;3;irtY�',7 ,n. - .� .. . .
<br /> "'...F:: v'r :.�.- .':.�'..; s2-?'�''�'-" .wQ;,- ab�:.
<br /> Job Address �030. � (� 1%y�( l (5 ',.��- �3J'"�"' Lot# �
<br /> Sub Diviaion per�e�#
<br /> . ...,^X": ,'.:2a�"..L i4' . .'Y��€= '%°t w . :",�X�'.��F:F��+4�i��W,'ri.i.�t. .. . ' , .. . ✓. . � ... .. � • i
<br /> 'd1��27�;'�:2 i.a.R'�d�:.,-.k�GiP.u4�t..4't-ri.?n, . �,. _ . , v fi' ..
<br /> � Bio-Hazard Waste S�rage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Materiai(Tier II or RQ Facilfty)ANNUAL
<br /> � Controiled Bum � Hood Installatlon
<br /> � Emargency Generator<3p�r � LPMatural Gas-InstallaUon
<br /> � Emergency Ganerator>30 kw � LPMatural Gas-ANNUAL Sale
<br /> � Fre Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL,
<br /> � � r
<br /> Sprinkler � ❑ ❑ � � Recreadonal Bum � � �
<br /> Flr+s Alartn � O � O � � Sparlclers �� �
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler Systam InstallaUons
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fre Alartn installatlon � Torch RoofinglTar Kettle
<br /> Fire Pumps � Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application-ANNUAL Valuation Of ProjeCt
<br /> Fuel Tanks
<br /> Q r.
<br /> . , �„ , ..a, �. ;<:�rs-�,� .�a:.�.,..,.r . . , .�,.�>r�.. ,.. ....�ti- :, as .. -. � . ;
<br /> �-.�:�• _�x.. �: .._.�:N,- ���. v;w: .. . . _ ,.
<br /> CoMractor ComP�Y O F�I r� _C�" � 1�
<br /> Signature Registered Fea Curre� N
<br /> Addresa J '� - � '� � � License# p
<br /> ELECTRICIAN ���y
<br /> s�gnature Registered Y/N Fee current Y/N
<br /> Address License#
<br /> PLUMBER �m�m
<br /> Sig"eture Registered Y/N Fee Cumant Y/N
<br /> Address LiCenae#
<br /> MECHANI ���
<br /> Slgnawre Registered Y/N Fse cumant Y/N
<br /> �� Lfoanae#
<br /> OTHER ��rn
<br /> �9"e�re ��stered Y/N Fae CurreM Y/N
<br /> �^� License#
<br /> Directioos: .. . . .. ..... „ . .. , .. . ., .. ,.... _ , ..._. .� • _... . �:,.�-az�aesa,,.•r�a � ,._4..;.,..,�.�-.........,._ .m. ,..� ,. � . ._ ..
<br /> ..�,..
<br /> FlII out application canpletely.
<br /> Owner�Contractor aign back of appiicatlon.rrota�ized(Or,coPY of signed cornract with ownar)
<br /> If over s2500,a Nofloe of Commencement is requirod(Mschanical work over 55000)
<br /> S�PP�Y two(2)aets of drawfngs wfth applicebla documerrtation
<br /> Allow 10-14 days for revfew after submiqal date. Paroel#-obtained from Property Tax Notke(httpJ/appraiser.pascogov.com)
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