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Permit Application <br /> Date Received _ _ Phone Contact for Pertnit � ! L <br /> I �� b"�"""�a"�`--ri� - �.�..,.�„�J� � �� <br /> -�rw <br /> Owners Name i �t.c.J(i d 3 3� � "'L3wn �� � �� <br /> s Phone Number <br /> Owners Address <br /> Fee Simple Titleholder Name Titleholder Phone Number C� I I � <br /> Fee Simple TiUeholder Address L --� <br /> �� _ ---`�sc-_.Facc�as:�-.� .�"*'�-r.::�,. <br /> Job Address � <br /> Lot# <br /> Sub Drvision Parcel# <br /> � . _ _._.�r�,--.�..�-„�.-K......_.,_.v �----- -�a�:d...�,:�"r'- a���.�;�.:��'csc�.�:zdz�L <br /> � Bio-Hazard Waste Storage-ANNUAL a Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct a Hazartious Material(Tier II or RQ Facility)ANNUAL <br /> aControlled Bum a Hood Installation <br /> aEmergency Generator<30 kw a LP/Natural Gas-Installation <br /> a Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> aFire Protection Maintenance-ANNUAL � Places of Assembiy-ANNUAL <br /> ❑ TrTy emi � er <br /> Sprtnkler ❑ ❑ p � � Recreational Bum '�/ 3��� <br /> � � � <br /> Fire Alarm ❑ ❑ ❑ Spariclers <br /> Hood Cleanmg � p p p �� a Sp�nkler System Installations <br /> Hood Suppression �� ❑ � p � � Standpipes(Spnnkler Sys) <br /> aFire Alarm Installation � Torch RoofinglTar Kettle , <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> aFire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> aFuel Tanks <br /> Q Other: <br /> s�_ ���. -- -- .�.��•� --.� ��°�.�� �. �.- <br /> Contractor �- <br /> Company � � - �. /-�.-F��� {��/� �-'1 <br /> !`�^�-p��7 � <br /> Sig�ature Registered Y/�1 Fee Current Y/(� <br /> Address y7�( �"iG �c��r (4- -' <br /> T ( License# � �y���l �o�r���� <br /> ELECTRICIAN <br /> Company , <br /> Signature Registered Y/N Fee Current Y/(�) <br /> Address � <br /> License# <br /> PLUMBER Company � <br /> Signature Registered Y/(v Fee Current �'/N <br /> Address <br /> License# <br /> MECHANICAL <br /> Company <br /> Signature Registered Y/N Fee Current �'/N <br /> Address <br /> License# <br /> OTHER � <br /> Company <br /> Signature Registered Y/N Fee Current �'/N <br /> Address <br /> License# <br /> Directions: - - --- <br /> FII out application completely. <br /> Ow�er&Contractor sign back of application,notarized(Ot,copy of signed contract with owner) <br /> tf over$2500,a Notice of Commencement is required(Mechanical worlc over$5000) <br /> Supply two(2)sets of drawings with appficable documentation <br /> Allow 10-14 days for review after submittal date Parcei#-obtained from Pro Tax Notice h !/a <br /> � Pe�Y ( ttp' ppraiser.pascogov.com) <br />