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f�ermit Application <br /> Date Received � � � � Phone Contact for Permit l 3 ��7� <br /> _ ... .._.�.:�:� . ��G <br /> Owners Name � `c°,� v „� Ownefs Phone Number �I,3 �� i CT—� <br /> 'J � <br /> Owners Address ,3d �� �/t � �� �S �, 33� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� I I <br /> �—._—J <br /> Fee Simple TiUeholder Address <br /> �'"���1T' �i?'�s �������a:"��:y�'""" <br /> Job Address Lot# �� <br /> Sub Division Parcel# <br /> l?�i�. -—'�S"°—Cu'�,e`�'6`°ie,.""� � . :��'�<�c-�'•' ."'��:d.�c"" <br /> a Bio-Hazard Waste Storage-ANNUAL a Fumigation Tent ~ <br /> a Comm Exhaust Kitchen Hood/Duct a Hazardous Materiai(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum a Hood Installation � <br /> aEmergency Generator<30 kw a LP/Natural Gas-Installation � ��� <br /> aEmergency Generetor>30 kw a LP/Natural Gas-ANNUAL Sale �(J <br /> Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL � � [� <br /> �y em� �n er � � � <br /> Sprinkler � O 0 ❑ � � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � a Spariclers '� .� � <br /> Hood Cleaning � ❑ O O � a Spri�kler System Installations /�� <br /> Hood Suppression �'f r p � ❑ � a Siandpipes(Sprinkler Sys) l l <br /> � <br /> aFire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> aFire Works <br /> aFlammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> � Other: <br /> �._.F . �.. <br /> Contractor � Company � G - �• /-1--��r��f;1'�� <br /> Signature Registered Y/N Fee Current Y/N <br /> Address �-/7�/ .�iG �=�rr L4" - --� � License# �Q� �� <br /> � lY���1 1�. � <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/nJ <br /> Address License# <br /> PLUMBER Company <br /> 5ignature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICAL Company <br /> 5ignature 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 /> Uirecttons ' "'_ <br /> FII out applicaGon completely <br /> Owner&Contractor sign back of applicatio�,notarized(Or,copy of signed contract with ow�er) <br /> if over$2500,a Notice of Comme�cement is required(Mechanical work over$5000) <br /> Supply two(2)sets of drawings with applicable documentation <br /> Allow'10-14 days for review afrer submittal date. Parcel#-obtained from Property Tax Notice(httpJ/appraiser.pascogov.com) <br />