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���-,�„-.,,,�„ ..�,r ..�".r��r������� � ��� �un-UIJ'/UU-VVGI <br /> Permit Application <br /> ite Received � / 3 � / 5 I Phone Contact for Pertnit g/3 � ,�s�� � <br /> vners Name• ��v� �9—c� �wners Phone Number ff 7/j �Z UO <br /> vner's Address � /.�'7 Q// <br />:e Simple Titleholder Name Titiehoider Phone Number � � � <br />�e Simple Titieholder Address <br /> b Address ,/4 Lot# � <br /> ib Division Parcel# <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier 11 or RQ Faciiity)ANNUAL <br /> � Controlled Bum a Hood Instailation <br /> � Emergency Generator<30 kw a LP/Natural Gas-Installation <br /> aEmergency Generator>30 kw � LP/Naturel Gas-ANNUAL Sale �? <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAI. �'�\( �� <br /> �y emi � r � N <br /> Sprinkler � O ❑ ❑ � � Recreational Bum <br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � SprinklerSystem Installations <br /> Hood Suppression � ❑ ❑ � � o Standpipes(Sprinkler Sys) <br /> � Fire Alartn Installation � Toroh Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> mtractor �A���.�.����� Com an f:`/'� �;` /� //1 G <br />�nature �"`��- /'"'��'--"" Registered Y/N F Current Y/N <br /> Address �D• J �'� �cof O�Gx.� 63 License# <br /> ECTRICIAN Company <br />�nature � Registered Y/N Fce Curtent Y/N <br /> Address License# <br /> UMBER Company <br />�nature Registered Y/N Fae Current Y/N <br /> Add►ess License# <br />:CHANICAL Company <br />�nature Registered Y/N Fee Current Y/N <br /> Address License# <br /> HER Company <br /> inature Registered Y/N Fee Current Y/N <br /> Address License# <br /> ections: <br /> Fill out application completely. <br /> Owner&Contractor sign back of applicaUon,notarized(Or,copy of signed contract with owner) <br /> Ii 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 />