Laserfiche WebLink
�'ermit Applicatron <br /> Date Received _ <br /> Phone Contact for Permit �3 Lt 7�i � <br /> Ovmers Name � �� � -- �- <br /> Owners Phone Number � � '� <br /> Owners Address J <br /> Fee Simple Titleholder Name �� �� � <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> `�i'' "` -- ,�s,�e, —�. <br /> Job Address � � ,/� ; <br /> V � <br /> Sub Diwsion <br /> Lot# <br /> � ,�����L� _ Parcel# <br /> � '{'�_»_.,.�'',.�r`��x` � -.."' '�'„�:£?�"i�..��.°_'�;ex:,�iSc.�.2ss_ <br /> Bio-Hazard Waste Storage-ANNUAL a <br /> aFumigation Tent " <br /> Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> aControlled Bum � <br /> � Hood Installation <br /> Emergency Generator<30 kw � <br /> aLP/Natural Gas-installation <br /> Emergency Generator>30 kw a LP/Natural Gas-ANNUAL Sale <br /> aFire Protection Maintenance-ANNUAL � <br /> Places of Assembly-ANNUAL � ��/�\ �1 <br /> ❑� emi � er l!l/ <br /> Sprinkler � � 0 � <br /> ❑ Recrea6onal Bum <br /> Fire Alarm � � � �� � <br /> ❑ Sparklers <br /> Hood Cleaning � 0 � (—'-� � <br /> � L__J Sprinkler System Installations <br /> Hood Suppression � � 0 �� a <br /> � Standpipes(Spnnkler Sys) <br /> Fire Alartn Installation � <br /> aTorch Roofing/Tar Kettle <br /> Fire Pumps a <br /> � Waste Tire Storage ANNUAL <br /> Fire Works <br /> aFlammableApplication-ANNUAL �—�.�_.� <br /> � Fuel Tanks Valuation of Project <br /> � Other: <br /> Contractor `��-� l�=--v� <br /> �' <br /> Signature Company m G _ �, /�._F�r�m� <br /> Address y�o� �G Registered � Y/N I Fee Curre�t Y/N <br /> �crr l�?- <br /> ELECTRICIAN T � License# [- �Y���l�oof�.�o�� <br /> Signature Company <br /> Address <br /> Registered Y/N Fee Current �'/N <br /> License# <br /> PLUMBEI2 <br /> Signature Company <br /> Registered 1'/(�I 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 /> 5ignature Company <br /> Address <br /> Registered Y/N Fee Current Y/N <br />)irections: ''`�; License# <br /> Fill out application completely <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> tf over$2500,a Notice of Commencement is required(Mechanicai work over$5000) <br /> Supply two(2)sets of drawings with applicabie documentation <br /> Aliow 10-14 days for review after submittal date <br /> � Parcel#-obtained irum Property Tax Notice(httpJ/appraiser.pascogov.com) <br />