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F'ermft Application <br /> Date Received _ <br /> � ^ Phone Contact for Permit (3 Lt 7�i �� <br /> y �� <br /> Owners Name � C C�� ��� /t -- - , <br /> L Owners Phone Number � �� �� <br /> Owners Address ���� ��vl, �� <br /> i � � I (t <br /> 7 <br /> Fee Simple Titleholder(Vame � � �� <br /> Titleholder Pfione Number <br /> Fee Simple Titleholder Address <br /> - - :,�� <br /> Job Address <br /> Lot# �� <br /> Sub Division �� <br /> .�-.q-�... -- Parcel# <br /> aBio-Neza d Waste Storage-ANNUAL 9 ���`� ���`�' -�;,,, <br /> 0 o Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ Faciliry)qNNUAL <br /> � Controlled Bum a <br /> a Hood InstallaGon <br /> Emergency Generator<30 kw a - <br /> aLP/Natural Gas-Instaltation <br /> Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> aFire Protection Maintenance-ANNUAL � �� ��� � <br /> Places of Assemb�y-ANNUAL � <br /> ❑� emi � er � <br /> Sp�nkler � � � <br /> ❑ Recreational Bum <br /> Fire Alarm � � � � � <br /> ❑ Sparklers <br /> Hood Cleaning � � � � <br /> Hood Su Sprinkler System Installations <br /> ppression �r ❑ �/ ❑ � a <br /> � �� Standpipes(Sprinkler Sys) <br /> Fire Alarm Installatio� a <br /> � Torch Roofinglfar Kettle <br /> Fire Pumps � <br /> � Waste Tire Storage ANNUAL <br /> Fire Works <br /> � FlammableApplication-ANNUAL �� <br /> Q Fuei Tanks Valuation of Project <br /> Q Other: <br /> ♦'�L.F°YaN:J�54.-3ts'o-sm45^^b� <br /> CO�itr'dCtOf �, � °� <br /> Signature Company m G - � �-���J�� <br /> Address y7�/ �G Registered Y/N Fee Current <br /> Y/N <br /> �=c�rr C�- <br /> ELECTRICIAN T I � License# [� �Y���1 �on fa�o�� <br /> Signature Company <br /> Registered Y/N Fee Current �'/N <br /> Address <br /> License# <br /> PLUMBER <br /> Signature Company <br /> Registered Y/(� Fee Current �'/N <br /> Address <br /> License# <br /> MECHANICAL <br /> Signature Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> OTHER <br /> Signature Company <br /> Address <br /> Registered Y/N Fee Current Y/N <br />?irections: "'" License!F <br /> Fil out application completely <br /> Owner&Co�tractor sign 6ack of application,notarized(Or,copy of signed contract with owner) <br /> ff over$2500,a Notice of Commencement is required(Mechanical work over$5000) <br /> Supply two(2)sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date <br /> � Parcel f�-obtained from Property Tax Notice(httpJ/appraiser.pascogov.�om� <br />