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a�saso-oozo c,iry or�epnyrnnis rire rax-ai a-iuu-uun <br /> Permit Application <br /> Date Received , f_��I"I L Phone Contact for Permit �/� �� 6 � � <br /> ° - - . . ._ <br /> Owner's Name -� lJ��,?t c� � Owner's Phone Number C� � � <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number C� � � <br /> Fee Simple Titleholder Address <br /> ! ` "�,."al .�°M^.}"'$���",^a�k'1`�'�%�£:':.a:��,�u.Y',,�,-Y:'�.2,,�..'+'�.�'+,°"'_' ' :':P.'.•„:..3'..�L"�:.. .'�.°� ;e�''P"!S�. 4�!'�"___ _ ' ^ � ' ..'tn,Y'" . <br /> Job Address �L/ �j �ul( ���� r�C �3 s�/ 2 Lot# � <br /> Sub Division Parcel# <br /> E u� �..y�.,' . ..",� ... . . _ _ °'.TMOf,-z`?_d^X"-bC3'.»,vn_-„s .�'v. _ .�«?R'��w:�h�"�+t'$y'.%",vu"difiM. _ _ _ -'9'°'�"N , .__ . '�."�'rroC&?�;'�:�"^f.sg*_.r <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ F�acility)ANNUAL <br /> � Controlled Burn � Hood Installation r,%- <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale �� <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL !n / <br /> �y emi �n er �,� <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Insta►lations <br /> Hood Suppression � ❑ � ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm installation a Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> � a-��{..�..., �-.s�,-..:�...:,�,����.�� �:��:�,������-�:�;�;.;��.�,�:.._ w:_..,�.,�.... .f,��,:��,;:��$�,� �,.w._����w.-:�� .... <br /> Contractor Company C-,%Y ` ��� � <br /> Signature Registered Y/N Fee Current Y/N <br /> Address � " �/ v�(,,� �, ' License# <br /> ELECTRICIAN 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 Curtent Y/N <br /> Address License# <br /> OTHER Company <br /> Sig�ature Registered Y/N Fee�Current Y/N <br /> Address License# <br /> r , <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 />