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_ _ �{,s-,au-vu�u t;rry or�epnyrrnits r�re rax-�s�.s-rau-uu�� <br /> ` Permit Application <br /> Oate Received � � Phone Contact for Permit _�� ��( 7 7 <br /> :.. ._.,.<.�-•.�•e.� ���..,�w�=<s��=�-:_��.���.„P..�_.-r:,�.:_.��- - . _. .. �� s� � s--°�--� �.. .. . <br /> Qwner's IVame '�' � (�tI�L Owners Phone Number �—S��� �� �' b <br /> Owner's Address 3 �� �,{„ � <br /> Fee Simple Titiehoider Name TiUehaider Phone Number �� �� [� <br /> Fee 5imple Ti(leholder Address <br /> .,,;:�-�..,,�;� §:2�»'$�Fr.. N.a'§�r"•.�..°`. <br /> Job Address t (,� d�17 � y Lot t� C� <br /> Sub Division Parcei# <br /> _ �--� � „ . �-�f����-�,-s�h�. . �. �., ..�^°: . _ .._ . , . �.v:a,.. 3,� - ,.�,:, <br /> o Bio-Hazard Waste Storage-ANNUAL � Fumigation Ter�t <br /> Q Cumm Exhaust Kitchan tiood/Duct Q Fiazardous Material{Tier II or RQ Facitity),ANNUAL <br /> � Controfled 8urn o Hood Instailation � <br /> QEmergency Generatar<3Q kw � LP/Naturai Gas-tnstallation%'f <br /> QEmergency Gerierato�>30 kw Q LPINaturel Gas-ANNU Sale <br /> � Fire Protection Maintenar�ce-ANNiIAI. Q Places of Assembly- NNUAL ` ��f Q <br /> � �� � � � <br /> � Sprinkler � ❑ D i� � � RecreaGonel Bum f <br /> Fire Alartn � Ct D Q U � Sparklers <br /> liood Cleaning � ❑ ❑ ❑ � � Sprinkler System Instalia s <br /> Hood Suppression � O ❑ O � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm instailation o Torch Roofing/Tar KetUe <br /> � Fire Pumps � Waste Tire Storage ANNUAk. <br /> Fire Works <br /> Flammable Appiica on-ANNUAL r , Valuation of Project <br /> � <br /> fuei Tanks <br /> � �th@f: <br /> ,. ' z"�'t`...::�.i�w.oi�:ak�:sc , . �� « «xa m4a�9-rc:.>w: :>a�.�a. �,-g°. •-�� <br /> Contractor Company <br /> Signatura Q.[.�-�. Registered Y!N Fee Gunent Y/N <br /> Addrass Q Z License# <br /> ELECTRICIAN Company <br /> Signature Registered Y 1 N Fee Curcent Y/N <br /> Address License# <br /> PLUMBER CompaRy <br /> Signature Registerec! Y/N Fee Current Y/N <br /> Address License# <br /> MiECNAIViCAL Cp��y <br /> Signature Registered Y!N Fee Current Y!N <br /> Address License# <br /> O7HEf2 ComPe�Y <br /> Signature Registered Y/N Fee Current Y/N <br /> Address �����# <br /> .. � - .. _ , , __ . . ..e...x�,.,<..a, u .,.« .,. . r..+. ;ee......:.K.,. ?ra�av==.x�s w.. .�X'�'# �, .R2."+n saa�X�t�.r��. a�ss��'�s, —'ims�.s."�v�, �• - <br /> Directions: <br /> Filt out application compl@tely. <br /> Owner 8 Contractor sign back of application,notarized(a,copy of signed corrtract with owner) <br /> if over$2500,a Notice af Commencement is raquirad(Mechanicai work over$5000) <br /> Supply fwo(2)sets of drawings with appiicabie documentation <br /> Ailow 10-f4 days for review after submiitai date. Parcei#-obYained from PropeRy Tax NoUce(http:Jlappraiser.pascogov.com) <br />