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813-78U-002U �iry or�epnyrrnns rire rax-ai s-itsu-uu�� <br /> Permit Application <br /> Date Received ,� Z � ��Z- Phone Contact for Permit ��3 �+ ls <br /> x <br /> Owner's Name �-rr / //�ZYi�.A-� L Ovmer's Phone Number C� � �� <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number C� �� �� <br /> Fee Simple Titleholder Address � ,, <br /> ���;��.� -�,�,,���,.,M,.� <br /> �,g ��::., °«as;�;�rr�:��.�; �;,�- ,.�,;.r. .,;�.., _. :...M=���°•.,_ � � <br />& �..._ � _ <br /> Job Address 3�� � � � � /`/4� � �l�'� 3 3 ��� Z Lot# <br /> Sub Division Parcel# <br /> �,.:.� .�._e • _ ..:a��.-,.�.��, <br />' m. . ,�Fe:�=�- ,�rsv�Y�u�°zgC ___ a€���!�4��'ac..Aaa;z-K.x>�x.;�.m._a,... � �+���.,em4:+r�u�;.,s..,-z;:n_ _ _ _- . .._. .+R�.'z��s7+n"'�. � <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <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 /'� j <br /> `-'�� r y emi �n er j ,�/ j �� �� <br /> ❑ � � Recreational Burn � 1/� � � J <br /> Sprinkler � � � / <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers ' <br /> Hood Cleaning � ❑ ❑ ❑ L� � Sprinkler System Installations '� <br /> Hood Suppression � ❑ ❑ ❑ � � Sta�dpipes(Sprinkler Sys) <br /> aFire Alarm Installation � Torch RoofinglTar 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 /> g >,�.�•.��:;:��:,�.,.:4.�. ��.a.���..:���_.� ��„_>��-���:,��,r��.� _ �,;�� .,. -�- _, •.:.. . :�..,.�...� _�R,��;�.r��,�_ . �� >.. �� <br /> Contractor Company _ ; -� � <br /> Signature % Registered Y/N ee Current Y/N <br /> Address a i �3 �,�t ' ` cc C� 3 (o� � 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 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 8 Contractor sign back of appiication,notarized(Or,copy of signed contract with owner) <br /> If over$2500,a Notice of Commencement is required(Mechanical work over$5000) <br /> Supply Mro(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 />