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n�s-,nu-uu�u �iry or cepnyrnu�s rire raX-�,,s-rau-uu�� <br /> Permit Applica#ion <br /> Date Received �`r�� Phone Coniacttor Permit J'^S� 7 t �7 <br /> -� .:•-�-.«�-�. ,,. :,-�.�����.�r�-a:�:�-�_�--,-�--->,�-.__-e.-^c•--: _����-������_.._.. -- ---��. <br /> Owner's Name J� � /V�� dwner's Phone Number 8 1 3 .� [.LI � 1 ,E' f� <br /> dwner's Address Q Q �{� <br /> Fee Simple Titlahoider Name Tftiehaider Phone Number �� � [� <br /> Fee 5imple Tittehoider Address <br /> °h•::..:�"»jt�r�'={9 �.a'wy'pP:;' _ . M�ss*."'';�3�d�' <br /> Job Address �(� � O (� { Lot� � �� <br /> Sub Division Parcel# <br /> . ._.. ._. - �„,., ...e,� �°s.:''^•;�u�. .. �+.< . . . . . -t�=�i'x•�z.TNr�sr^- , �-�*�-�,,. <br /> � Bio•Hazard Wasta Storage-ANNUAL � FumigaSon Tent <br /> Q Comm Exhaust Kitchen Hoad/Duct � HazaMous Materiai{Tler It or RQ Facility}ANNUAL <br /> � Contcalled Bum Q Hood Instailation <br /> QEmergency Generator<30 kw � LPiNatural Gas-Instatletion <br /> aEmergency Generalor>30 kw Q LP/Naturel Gas-ANNUAL Sale <br /> � <br /> Q Fire Protection Maintenance-ANNUAL o Places of Assembly-ANNUAL �' J <br /> � �� � (��/ <br /> �(' Sprinkler � CJ � � � � Recreational Bum �j � <br /> Fire Alarm � ❑ Gl G7 � � Sparkiars <br /> / f <br /> Hood Cleaning � ❑ ❑ t� � � Sprinkler System Installatio <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes{Sprinkier Sys) <br /> � Fire Alarm InstaitaGOn o Torch RoofingfTar Kettte � <br /> � Fire Pumps � Waste Tire Storage ANNUAI <br /> � Fire Works <br /> � Flammable Applicatiorl-ANNUAL �_— � Valuation of Project <br /> Fuel Tanks <br /> [� other. <br /> < .�.�.�. �r.��::��� �>.& , . _, <br /> . ��a����:.. � 3 5��� <br /> CoMractor Company <br /> Signature � �(�—� Registered Y/N Fee Current Y/N <br /> Address 'L l.icense# <br /> ELECTRICIAN Company <br /> Signalure Registerad Y I N Fee Current Y/N <br /> Address Lice�se# <br /> PLUMBER Company <br /> Signature Registered Y/N Fea Current Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y!N Fee Cunent Y!N <br /> Address License# <br /> OTHER Company <br /> Signature Registered Y!N Fee Current Y/N <br /> Address License# <br /> �7,;�. ^s� ,a�s.�a. i�mX .w.a°'r�e;s�+a�=E°��,.i.��`8+.^s C�F.'x e +� , .. ., <br /> .Directions: <br /> Fill out appiication completely <br /> Owner&Cont►actor sign back of applicaiion,notarized(Or,Copy of signed coMrect with owner) <br /> I#over$2500,a Notice a(Commencement is requirod(Mechanical woric over$5000) <br /> Supply two(2}sets of drawfngs with appiicable documenfatton <br /> Allow 1Q-14 days for review aRer submitta!date. Parcei#-obtained from Property 7ax Notice(http:t/appraiser.pascogov.com) <br />