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ai3-�8o-oozo �ity or cepnyrnius rire rax-tsis-i�su-uun
<br /> Permit Application
<br /> Date Received S 'Z�'�L Phone Contact for Permit �'�j qf'� �/f,
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<br /> Owner's Name PP[ G"�/H J�j�f� Owner's Phone Number C� � �
<br /> Owner's Address
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address
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<br /> Job Address (v��� ���-J✓l� ,� � .�w�� � Lot# �
<br /> Sub Division Parcel#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier 11 or RQ Facility)ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> � Emergency Generator<30 kw � LP/Naturai Gas-Installatio�
<br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale;��
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<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNU � C�
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<br /> Sprinkler ❑ ❑ ❑ Recreational Bum � / / !�`,�
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers / � � '�%�
<br /> Hood Cleaning � � ❑ O � � Sprinkler System Installations �"~---°�""`-��
<br /> Hood Suppression � ❑ � ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation � 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 Other:
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<br /> Contractor Company F=r'� �` c
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address � Ga�d����G 6 � 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 r
<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)
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