Laserfiche WebLink
Permit Application <br /> Date Rec:e?bed ^^ ^ Phone Contact for Permit (3 L�7�i <br /> . _ - .:..�:.�.�:w�. �� <br /> Owners Name C��i f �te�� Owners Phone Number <br /> Owners Address � �� �� <br /> Fee Simple Titleholder Name Titleholder Phone Number C� �� � <br /> Fee Simple TiUeholder Address <br /> � <br /> 3 � - ��..��.�.�:,�� <br /> Job Address �� <br /> Lot# <br /> Sub Division <br /> rcur��. <br /> Parcel# <br /> � �r ..-_ c'�+.'1.�5' �e��cir.t�..c�� . <br /> Bio-Hazard Waste Storage-ANNUAL a <br /> � Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct � Hazardous Matenal(Tier II or RQ Faciliry)qNNUAL <br /> � Controlled Bum a Hood Installa6on <br /> aEmergency Generator<30 kw a LP/Natural Gas-Installation <br /> a Emergency Generator>30 kw � �P/Natural Gas-AN►JUAL Saie <br /> aFire Protection Maintenance-ANNUAL a � � _`O�� <br /> Places of Assembly-ANNUqL �L <br /> ❑ r7y emi �n er a <br /> Sprinkler ❑ ❑ ❑ RecreaGonal Bum <br /> Fire Alarm � ❑ ❑ p � � Spariclers <br /> Hood Cieaning � ❑ ❑ p �� � Sprinkler System Installations <br /> Hood Suppression �j� .t p � � (�-I � <br /> a .1 L_� Standpipes(Sprinkler Sys) <br /> Fire Alarm Installation a Torch RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Worlcs <br /> � Ftammable Application-ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> � <br /> ��,�,�- -- - <br /> Contractor �'-�'�"*� <br /> Signature / Company m e _ �, /�._��r��� <br /> Registered Y/N Fee Current Y/N <br /> Address y"�(^if C`�iG �-cc�r- L4- - .-T� <br /> ELECTRICIAN � License# [� �y���l�o�j���� <br /> Signature <br /> Company <br /> Registered Y/N Fee Current �'1(y <br /> Address <br /> License# <br /> PLUMBER <br /> Signature Company <br /> Registered Y/N Fee Current Y/nf <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 /> Registered Y/N Fee Current Y/►� <br /> Address <br /> Di�ections: License# <br /> FII out applicaGon completely <br /> Ow�er&Contractor sign back of applicatio�,notarized(Or,copy of sig�ed 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. Parcel#-obtained from Property Tax Notice h J/a <br /> � � ttA" ppraiser.pascogov.com) <br />