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ais-�ao-oczc l;iry ot cepnyrnins rire rax-aia-iuu-wn <br /> Permit Application <br /> Date Received �� Phone Contact for Permit �3 �j� � <br /> � . <br /> Owner's Name '�/rL.L.-//�/�/CE � �f��'/� ��G zE H/ p�,y�er's Phone Number g� � �� <br /> Owner'sAddress '� � /� 0/Q�� ��] /� lT1� L � 3 s'ua <br /> Fee Simple Titleholder Name Titleholder Phone Number C� � C� <br /> Fee Simple Titleholder Address <br /> ? . _ ^`�"'�' . _ _'�-.�.et�-:S:�yw„t•.. . .- �_� . , :K�r-r�°��9k.'R:� �_ - . x . .. <br /> -- Ml����.„`-,"_, _ _ ;,."�°�? <br /> Job Address �� <br /> Lot# <br /> Sub Division Parcel# <br /> k r .,:, : „ � � - _ _ - x4+,bF,°4-:��,m.<�ulB.�Y�'t�s�ama'.:..�,-�..>.�,y`°.,re,, .-,- .w�r�!'%�,�,�.aaaa:P��aw.-�e� _ <br /> . . _- ` _ _ .- '��t�Y� - .., a�`,.zr.:'?��v.a«a9^a.3,F-Y,,�'-R';�p^:.z? <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ F�acility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> aFire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> ry emi �n er �%2 �f�� <br /> ( �..J (." <br /> Sprinkler � ❑ ❑ ❑ � Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm installation � Torch Roofing/Tar Kettle <br /> aFire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br />� ` .^r�,1H'.-.-s.,kr ��,�,`e-g;�-�ra'€�- �aR�'�*��R��,•.�:•=�px-^��?���<-S�t��mu�"5�:;,+�.�..�^y'in"«�..:•. ,. ��:«'dFF.n�'",°e.^.�,:�a� <br /> "a�e`°.'�.`-p�,"#'�.E:ic^s�w#3*"K}:'F:3.^.'si.:,.Sw3�=,i;k'9a•"'.'"��.!' .-. <br /> COntMCtOf <br /> Signature Y _ Company <br /> ��1�!/Ni /� + Registered Y/N Fee c;urrent Y/N <br /> Address <br /> License# <br /> ELECTRiCIAN Company <br /> Signature Registered Y/N Fee(;urrent Y/N <br /> Address License# <br /> PLUMBER <br /> Company <br /> Signature Registered Y/N Fee C:urrent Y/N <br /> Address <br /> License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee C:urrent Y/N <br /> Address <br /> License# <br /> OTHER <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> Directions: <br /> Fill out application completely <br /> Owner 8 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) <br />