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��3-ru�,-uu�,,� LiII}/pT L@pfly('f111t5 t'If8 <br /> - rax-t�i,�-itsu-uuz� <br /> - Permit Appiication <br /> Date Received <br /> � il , «.«r��..:afi,�„�,.« ���,x<.,��`��-�:,�r Phone Corttact for Permit � � <br /> �--,—.�;.�....-,c,�,.,.,.: _. . . ����,... <br /> Owner's tJame , Ovmers Phone Number Y�� � <br /> �7 �� 9 0 0 <br /> Owner's Address 3 � <br /> Fee Simple TitEeholder Name Titiehalder Phane Nwnber � �� � <br /> Fee Simple Titieholder Address <br /> k. , •,,�s�.:�zv_^� <br /> r�=��.,�'��..x;.�'�.�:�,:�- <br /> Job Address ��V r.., � <br /> Lot# �� <br /> Sub Division <br /> .. . _. Parcei# <br /> . ,.�.. -,.,�-.-����, ,. <br /> Q .. . _� ��°°��=�:.�R�.���.:��. <br /> Bio-Hazard Wasta Storage-ANNUAL � Fumigation TeM <br /> Q Comm Exfiaust Kitchen Hood/duct � HazaMous Materiat(Tier It or RQ Facility)ANNUAL <br /> � Controlled Bum o Hood instaUatian <br /> QEmergancy Generaior<30 kw � Lp/tVatura�Gas-I�stallation ,%` <br /> � Eme�ency C�nerator>30 kw � LP/Naturel Gas-ANNUAL Sale r <br /> QFire Protection Maintenance-I�NNUqI, a piaces of Assembly-ANNU //� � <br /> X Sprinkier p ❑ / � �f <br /> � Y �� � � � Recreationai Bum �/ <br /> Fire Atartn � q Q ❑ � � g�rkiers <br /> Hood Geaning � p ❑ ❑ � Q Sprinkler System tnstallatiorts � <br /> Hood Suppression � O ❑ ❑ C� � Standpipes(Sprinkler Sys) <br /> � Fire Alarm InstaUation � Torch RoofingfTar KetUs <br /> � Fire Pumps � Waste Tira Storage ANNUAI <br /> � Fire Works <br /> Flammabte ApplicaUon-ANNUAt ��' <br /> D � , Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> .. +'r ke��4:.;�• �i'��S`'=i��tira <br /> Contractor -���»°`°^�° �$".'��° <br /> Signature <br /> Company <br /> Ragistered Y I N Fea CuRent Y!N <br /> Address V 'L licen5e# �', <br /> ELECTF2ICIA <br /> Signature ��ny <br /> Reglgtered Y/N Fee Cuneni Y/N <br /> Address <br /> License i� � <br /> PLUMBER <br /> Signature <br /> Company <br /> Registered Y/N Fee Current Y 1 N <br /> Address Llcense# '1 <br /> MECHANlCAI � <br /> Signature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> 07HER <br /> Signature �pany <br /> Registered Y/N Fee Current Y i N <br /> Address <br /> �Directions: s = .. �. �" . ' �' �: . .e ;�,:��cense# �� <br /> . .rka a4��:�"x�*'�.'.�':�•r'�c'.�{�q--�i-.. � �- <br /> Fili out appiication comptetely. <br /> Owner&Confraclor sign back of appiication,notarized(C3r,copy of signed coMract with owner) <br /> !f over$2500,a NoUce of Comrr�encement is requirnd(Mechanicat work over$500p) <br /> Supply two(2�sets of drawings with appiicable dxumentation <br /> Ailow 10-14 days for review after submiftat date. Parcef#-opfairted from Property Tax Notice(http:llappreiser.pascogov.com) <br />