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Permit Application <br /> Date Received Phone Contact for Pertnit l 3 �t?� �� <br /> Owners Name L� y- S ���¢� �/-f.l� " Owners Phone Number �� �� �� <br /> -� / ��/� L---- <br /> Owners Address ��`L-L /�L /� / �� � ����ls � � C'�-� V� <br /> Fee Simpie Titleholder Name Titleho(der Phone Number C� � �� <br /> �1 <br /> Fee Simpte TiUeholder Address <br /> �;s_�,. -dsa�am�zs+�.a�. ;r <br /> Job Address Lot# C� <br /> Sub Division Parcel# <br /> c?;�+� - - � :�,--'t�.�����si:�s <br /> a Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct a Hazandous Material(Tier II or RQ Facility)ANNUAL <br /> aControlled Bum a Hood Installation <br /> � Emergency Generator<30 kw a LPlNat�ral Gas-Installation <br /> a Emerge�cy Gene2tor>30 kw a LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance-ANNUAL � Places of Assembiy-ANNUAL <br /> � emi � er <br /> Sprinkler � p ❑ ❑ � � RecreaGonal Bum � 2 9G�C,� <br /> `� ✓ l ( � <br /> Fire Alarm � ❑ ❑ ❑ � � Spariclers <br /> Hood Cleaning O O ❑ � a Sprinkler System Installations <br /> Hood Suppression � t ❑ � p � � Standpipes(Sprinkler Sys) <br /> � Fire Alartn Installatio� � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> aFire Works <br /> aFlammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> �_+� ��-�:� <br /> Contractor �' Company m G - � /-}-F���f;V��j <br /> Signature Registered Y/I� Fee Cutrent Y/N <br /> Address y�("i/ �iG �-c�rr l�- - �" ( License# C7QC� ���C�C <br /> � /Y�3�1 ra � <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current �'/N <br /> Address License# <br /> PLUMBER Company � <br /> Signature Registered � Y�N I Fee Current Y/►J <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/nl <br /> Address License# <br /> OTHER Company <br /> Signature Registered ( Y%fV I Fee CuRent Y/N <br /> Address <br /> License# <br /> y - ' - <br /> Directions: <br /> FII out applicaGon complete�y <br /> Owner&Contractor sign back of application,notariied(Or,copy of signed contract with ow�ev) <br /> H over$2500,a Notice of Commencement is required(Ntechanical woric over$5000) <br /> Supply two(2)sets of drawings with applicable documentatio� <br /> Allow 10-14 days for review afrer submittal date. Parcel#-obtained from Prvperty Tax Notice(http//appraiser.pascogov.com) <br />