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w , zsio-�uu-vutu �iry or�epnyrnu�s rire rax-tt�s-iau-vuzi <br /> Permit Applicatian <br /> Date Received �� � Phone Contact for Permit �' ���i St � « �>?7 <br /> w�;�' xtASintAAA�e.�.;.;�.—�"'�'^^.�r-..,-.-. -^-.;s•-a-�-k".:?''' ' ._ ._�T.+o�'���rr�;�4,.z.<, h <br /> Owner's Name �O�s Owners Phone Number C�!.� C�E'J � p <br /> Owner's Address � Q <br /> Fee Simple Titieholder Name Tftiehoider Phone Number C� �� C� <br /> Fee 5impie Tit{eholder Address <br /> � , , ,.,h^�e�'s�4�.. . . <br /> 3 7 � _ �-.>;�;-�:�;%Y:s �. <br /> Job Address t.� � (�'t� lot# �� <br /> Sub Division Pa��� <br /> , �.. .-. . , ��.������;ma�- ,. ,_ .. . . �;,{.�,-,���--� <br /> o Bio-Ffazard Waste Storage-ANNUAL � Fumigation TeM <br /> QComrn Exhaust Kitchen Hood/Duct o Hazardous Materiai(Tier 1►or RQ Facifity)ANNUAL <br /> Controlled Btxn � Hood lnstaliation <br /> QEmargency Generator<30 kw � �P/Natural Gas-I�statlation <br /> a Emergency Generator>30 kw � lP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Main4enance-ANNUAL Q Places of Assembly-ANNU /'��/ <br /> ry emE �� � V O <br /> � Sprinkler � l7 D Recreationai Bum /� d <br /> Fire Alarm � D C7 C7 � � Sparkiers ( <br /> Haod Gleaning � ❑ ❑ ❑ �� � Sprinkler System Installations <br /> Hood Suppression � p ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Atarm Insialiation o Torch RoofingtTar Ketde <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Fiammable Application-ANNUAL �— � Valuation of Project <br /> Fuel Tanks <br /> [� Other: <br /> , . .���,.:.x-«�..�a-��.,�:..>- <br /> . . e:�:i�� r <br /> Contractor Company <br /> Signature Registered Y/N Fae Current Y(N <br /> Address license# <br /> ELEC7RICIAN ��y <br /> Signature Registered Y/N Fee Current Y/M <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICAL �m��y <br /> Signature R�'tstered Y/N Fee Current Y/(d <br /> Address License t� <br /> OTHER Company <br /> Signature Registered Y(N Fee Gurrent Y!N <br /> Address Lic�nse# <br /> , . ...�...�.�. . _ _ . s� . .��� �� � ��� �. ;:.E . .. �,�t <br /> Directians: <br /> Fill oui application completely <br /> Owner 8�Contractor sign back of applicaiion,notarized(Or,copy of sFgned contract with owrrer) <br /> if over$2500,a Nalice af Commencement is requirsd(Mechanical work over$5000) <br /> Supply two(2)sets of draHrings with applicabie documerrtatton <br /> Allow 10-14 days for review afler submittai date. Parce{#-obiained from Property Tax Notice(http:ltappraiser,pascogov.com) <br />