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� v�ay vi�.c���y�iiuw� uo rax-25i's-780-0021 <br /> . , Permit Application <br /> Date Received Phone Contact for Pertnit� !3 L�7�i ��J <br /> _ s <br /> Owners Name ('�'�--�—�� <br /> � Qwners Phone Number ��3 I �G I <br /> Owners Address �8'.�j/� L'a � �� <br /> � ,P Z .� =� 33s- <br /> Fee Simple Titleholder Name Titleholder Phone Number � � �� <br /> Fee Simple TiUeholder Address <br /> � `L..�:=9"-- -.�:�-s-s"t'.an��c�-- .arw�."nw�n�'�.-�isi'^mv _ <br /> Job Address �� <br /> Lot# <br /> Sub Division Parcei# <br /> � � �.-�--,�--=._x ��-�.S.;�ar_- - .;- ..z_ - <br /> o :...��.�:.._�-�. - , <br /> Bio-Hazard Waste Storage-ANNUAL a Fumigation Tent <br /> aComm Exhaust Kitchen Hood/Duct a Hazardous Matenal(Tier II or RQ Facility)ANNUA�, <br /> QControlled Bum a Hood I�stallation •' <br /> � Emergency Generator<30 kw a LP/Natural Gas-Installation ,,%��+ ; <br /> a �- <br /> Emergency Generetor>30 kw � LP/Naturel Gas-ANNUAL Sale J ��j � <br /> aFire Protection Maintena�ce-ANNUAL a Places of Assembly-ANNUAL ��l �`�� � .�.-� <br /> ❑� em� � er � <br /> Sprinkler ❑ ❑ p � a Recreational Bum ��Y <br /> Fire Alami � p ❑ ❑ �� a Sparklers ~ <br /> Hood Cleaning � ❑ � ❑ C� a Sprinkler System Installations <br /> Hood Suppression � t ❑ ❑ � a Standpipes(Sp�nkler Sys) <br /> � Fire Alartn Installatio� a Torch Roofing/Tar Kettle <br /> a Fire Pumps � Waste Tire Storage ANNUAL <br /> aFire Worics <br /> aFlammable Application-ANNUAL � <br /> � Valuation of Project <br /> Fuei Tanks <br /> Q Ofher: <br /> Contracfor �' Com an <br /> a v Yrl G - j`J /.�-F�,-�Y�-�� <br /> Sig�ature Registered Y/N Fee Current Y/N <br /> Address y"]�( ,�"iG �-r�rr C4" '-�` <br /> � License# � �y���1 ��n ra��� <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y/N Fee CuRent �'/(v <br /> Address <br /> License# <br /> PLUMBER <br /> Signature Company <br /> Registered Y/N Fee Current �'/N <br /> Address <br /> License# <br /> MECHANICAL <br /> 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 applicafion completely <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> tf over$2500,a Notice of Commencement is required(Mechanical work over$5000) <br /> Supply two(2)sets of drawings wittt applicable docume�tatio� <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice h J/a <br /> i ( ttp' ppraiser.pascogov.com) <br />