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rermit Nppucatron <br /> ��ate RE t;ived - _ <br /> ^ Phone Contact for Permit (3 �t?�i �� <br /> �-�- . <br /> Qwners Name ..��,�.� �� 1r�. , <br /> Qwners Phone Number C� � ��"'� <br /> Owners Address S'�'j�j �i�rL-G -3�//� � ��/ J <br /> Fee Simple Titleholder Name �� �� � <br /> Titleholder Phone Number <br /> Fee Simple TiUeholder Address <br /> -- �� <br /> ��r.�. ��3'-'�:^sax Z <br /> Job Address ' ' <br /> Lot# � <br /> Sub Diwsion .J <br /> Parcel# <br /> _ � ;��-r.�,- ��-� <br /> o � - - .��.�-�.�.�:� . <br /> Bio-Hazard Waste Sto2ge-ANNUAL � <br /> aFumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct a Hazardous Matenal(Tier II or RQ Facility)qNNUAL <br /> � Controlled Bum a <br /> a Hood I�stallation <br /> Emergency Generator<30 kw a <br /> � LP/Natural Gas-Installation <br /> Emergency Generetor>30 kw a LP1Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � <br /> Places of Assembly-ANNUAI <br /> ❑�r1y em� nf er � j�^ <br /> Sprinkler O O O �f�� � <br /> � RecreaUonai Bum f -� ( <br /> Fire Alarm ❑ � � � � � <br /> � � Sparklers � <br /> Hood Cleaning �p <br /> !'` � � � � Sprinkler System Installations <br /> Hood Suppression � t � � <br /> � Standpipes(Sprinkler Sys) <br /> Fire Alarm Installation a Torch Roofing/Tar Kettle <br /> a Fire Pumps a Waste Tire Storage ANNUAL <br /> aFire Works <br /> aFlammable Application-ANNUAL <br /> aValuation of Project <br /> Fuei Tanks <br /> Q Other: <br /> Contracior � '" <br /> Signature Company y1'� G _ �, �_������ <br /> Registered Y/N Fee Curtent Y/N <br /> Address y'7(^i/ .�iG �-rc�r l4 - --T� <br /> ELECTRICIAN � License# � �y���l��o j���� <br /> Signature Company <br /> Registered Y/N Fee CuRent Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Signature Company <br /> Registered Y 1 N Fee Current Y/N <br /> Address <br /> License# <br /> MECHANICAL <br /> Signature Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> OTHER - <br /> Signature Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> Directions� License# <br /> Fill out application completely. <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> H 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 frvm Property Tax Notice h J/a <br /> � � ttP pp�aiser.pascogov.com) <br />