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�ozo t;ity ot�epnyrrnus rire <br /> rax-o i o-i ov-w�� <br /> Permit Application <br /> Phone Contact for Permit �o��7 `1�a �'�� <br /> Date Received . 4. �:�.�.-r:,�..,=*,:.,�.�w..«.,,-�._�._ - <br /> R .,,�,�„ . _, , <br /> «���m:.�s-�-,_x,:,�:w.s�.�_�:�:s..__,,.,_,_ <br /> Owner's Name d A � Ce <br /> � C�.C�c�.���S� Owner's Phone Number , gI�J 7 S 3 � b1� <br /> y37\ Veco���-0.S�SElo�o.�ec- ''(..5\Vd• ��: ers r-- 339 Ilc <br /> o�,ars Aadress �� � � <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Name <br /> Fee Simple Titleholder Address - __ ��,_�. - <br /> s�� '�' � <br /> , �„�,��i?�, _..... '�i�'"?�_'�' "�",�°°x'''�`r". - �� <br /> t:k.__._''��:a'�*,.��'� �. <br /> Job Address <br /> 38 O 1 O N� �c�\ C� '�e�- venue ��'# <br /> Parcel# <br /> Sub Division - - '� <br /> ,_�. _. ��m <br /> II�Je:ar�x:�_..:: � :. . . _ . . . _ . . � - � <br /> � Bio-Hazard Waste Storage-ANNUAL Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Faciliry)ANNUAL <br /> � Controlled Bum � Hood Instal�ation <br /> aEmergency Generator<30 kw a LP/Natural Gas-Installation <br /> � Emergency Generetor>30 kw � LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL ��� <br /> LI�LrI"y� emi � er ❑ <br /> Sprinkler � ❑ ❑ O Recreational Bum • <br /> Fire Alarm � 0 ❑ � � � Sparklers <br /> Hood Cleaning � ❑ ❑ O � � Sprinkier System�nstallations � <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) � <br /> a Torch Roofing/Tar Kettle �I � <br /> � Fire Alarm Installation a <br /> � Fire Pumps Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> aFuel Tanks <br /> � Other: � <br /> ln,,:{� ,. . . �#�. , . . . � '� , <br /> Contractor Company Q�re �'m `n <br /> Registered N Fee Curcent Y/N <br /> Signature <br /> Address , \'3'�11c L License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> License# <br /> Address <br /> PLUMBER Company <br /> Registered Y/N Fee Current Y/N " <br /> Signature <br /> License# <br /> Address <br /> MECHANICAL Company <br /> Registered Y/N Fee Current Y/N <br /> Signature <br /> License# <br /> Address <br /> OTHER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> License# <br /> Address , ., � ... . <br /> s � ,. .,. <br /> Directions: <br /> Fill out application completely. <br /> Owner&Contrector sign back of application,notarized(Or,copy of signed contract with owner) <br /> If over$2500,a Notice of Commencement is required(Mechanicai work over$5000) <br /> Supply iwo(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 />