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Permit Application -- <br /> Date Received ^ Phone Contact for Permit �3 �t 7� �� <br /> Owners Name �LSS �/�Q'J� Owners Phone Number �` � �,2 [���� <br /> Owners Address <br /> �O_�(r�� � �' �c �i f°�� f�� r� , <br /> Fee Simple Titleholder Name Titleholder Phone Number C� � �� <br /> Fee Simple TiUeholder Address <br /> •�.;�'�'�::. <br /> � � �Lot# <br /> Job Address <br /> Sub Division <br /> Parcel f� <br /> � ��;�;--- °���.�.�- �- - - - - ��•c���.:._�;��.� . <br /> � Bio-Hazard Waste Storage-ANNUAL a Fumigatio�Tent <br /> aComm Exhaust Kitchen Hood(Duct � Hazardous Matenai(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum a Hood Installation <br /> aEmergency Generator<30 kw � LP/Natural Gas-Installation <br /> aEmergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> aFire Protection Maintenance-ANNUAL a Places of Assembly-ANNUAL <br /> ❑�r y em� �n er � � 3 ! ! �/ <br /> Sprinkler ❑ ❑ ❑ � Recreational Bum ( <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood C�eaning � �I ❑ ❑ �� a Sp�nkler System Installations <br /> . � <br /> Hood Suppressio� � t ❑ O � a Standpipes(Spnnkler Sys) <br /> aFire Alartn Installation a Torch Roofingffar Kerile <br /> � Fire Pumps � Waste Tire Sforage ANNUAL <br /> � Fire Works <br /> ❑ Flammable Application-ANNUAL �_--� Valuation of Project <br /> � Fuel Ta�ks <br /> � Other: <br /> �w '� <br /> Contractor �' Company m � - �• � 'F�r��'� � <br /> Signature Registered Y/N Fee C�rrent Y/N <br /> Address �-/�("i/ !"sG �-fc�r �4- - 'T ( License# � /Y�3�1 ���t��=0`f <br /> ELECTRICIAN Company ' <br /> Signature Registered Y/N Fee CuRent Y/n) <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/nl Fee Curtent Y/N <br /> Address License# <br /> MECHANICAL Company -� <br /> Signature Registered Y/N Fee C:urrent Y/N . <br /> Address License# _ <br /> OTHER Company r- <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> w•--- - - -ac�s <br /> Directions: <br /> Fil out application completely <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> tf over 52500,a Notice of Commencement is required(fvlechanical woric over$5000) <br /> Supply two(2)sets ot drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Prnperty Tax Notice(httpJ/appraiser.pascogov.com) <br />