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Permit Application <br /> Date h:*_ceived l0' - �• Phone Co�tact for Permit !3 ��7� �� <br /> Owners Name � Owners Phone Number �� �� �� <br /> J <br /> Owners Address <br /> ��. <br /> Fee Simple Titleholder Name Titleholder Phone Number � � �� <br /> �J <br /> Fee Simpie TiUehalder Address <br /> � .x��� <br /> Job Address Lot# � <br /> Sub Diwsio� Parcel!# <br /> - - — - •���s"'��..�'x°�aP=...--aY�"�r�-1 i "-�""°'�c.-.'�€�'..�'��',�Sr:ti ' - <br /> aBio-Hazard Waste Storage-ANNUAL a Fumigation Tent <br /> Q Comm Exhaust Kitchen Hood/Duct � Hazardous Materiai(Tier II or RQ Faciliry)ANNUAL <br /> aControiled Bum � Hood Instaliation <br /> a Eme enc Generator<30 kw ,y'� <br /> rcJ Y � LP/Natural Gas-I�stallation L <br /> a Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale �'L ��� � /J <br /> a " <br /> Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er � ��j <br /> Sprinkler � ❑ ❑ ❑ � a Recreational Bum <br /> Fire Atarm ❑ ❑ O ❑ � � Spariclers � <br /> Hood Cleaning � ❑ ❑ O � � Sp�nkler System Inst ations �l <br /> Hood Suppression �t ❑ � ❑ � a Standpipes(Sprin r Sys) I � � <br /> aFire Alartn Installation a Torch RoofinglT r Kerile <br /> � Fire Pumps � Waste Tire Sto ge ANNUAL <br /> aFire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> FuelTanks <br /> Q Other: <br /> ����--:� =--1���. - — - <br /> Contracior �' Company m G - �• /-�-`�.r�,�.� <br /> Signature Registered Y/N Fee Current Y/N <br /> Address y"7�( l"iG �-4rr L�- - -T � License# � �Y�3�z1 �oo���� <br /> � <br /> ELECTRICIAN Company �— <br /> Signature Registered �� Y�N I Fee Current Y/N <br /> Address License# <br /> PLUMBER Company —' <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICAL Compa�y <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 <br /> License# <br /> Directions: <br /> Fiil out application completely <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> H over$2500,a No6ce of Commencement is required(Mechanical work over$5000) <br /> Supply two(2)sets of d2wings with applicabie documentation <br /> Aliow 10-14 days for review after submittal date. Parcel#-obtained from Praperty Tax Notice(http//appraiser.pascogov.com) <br />