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Permit Application <br /> Date Received - -= <br /> � ...��,�„--,,,a _ Phone Contact for Pertnit !3 Lt��i �� <br /> -�:.�-- <br /> Qwners Name � `�C s'�yy�w�� �� � �� <br /> �vners Phane Number <br /> Owners Address <br /> Fee Simple Titleholder Name Titleholder Phone Number C� U �� <br /> Fee Simple TiUeholder Address <br /> � -t.� <br /> -�-s�=�i-�-�w..�••.,.�..�9�P"h'�;.�_.+�.�""�S'�a: <br /> Job Address �•� � f 3 2 � �7 <br /> Lot# � I <br /> Sub Drvision _1 <br /> ��—�.,,�,,, Parcel# <br /> °"":.:a:: <br /> a � �.,. Y ,r ;.._ a -��� .��su.�.,s <br /> Bio-Hazard Waste Storage-ANNUAL a <br /> a Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum o Hood Installation <br /> � Emergency Generator<30 kw � LP/Natu21 Gas-Installation <br /> a Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL o � � y/�1 <br /> Places of Assembiy-ANNUAL <br /> ❑� emi � er a <br /> Sprinkler O O p <br /> Recreational Bum <br /> Fire Alarm ❑ � � � �� � <br /> ❑ Sparklers <br /> Hood Cleaning ❑ p p � a Sprinkler System Installations <br /> Hood Suppression �(/f p � � <br /> a ✓� Standpipes(Sprinkler Sys) <br /> Fire Alarm Installation � Torch RoofinglTar Ketlle <br /> aFire Pumps � Waste Tire Storage ANNUAL <br /> aFire Works <br /> � FlammableApplication-ANNUAL �� <br /> � Valuation of Project <br /> Fuel Tanks <br /> a Other: <br /> Contractor � "�'"�'�`��'�"'��"""'�' - <br /> � Com an �y� <br /> Signature p Y / ' f G - � �-��r���� <br /> Address Registered Y/N Fee Current �'/(� <br /> L/7�/ �G ��r [�'_ _ T <br /> ELECTRICIAN � License# � �Y�3�1 �p�r��r� <br /> Signature <br /> Company <br /> Registered Y/N Fee Current �'/N <br /> Address <br /> License# <br /> PLUMBER <br /> Signature Company <br /> Registered Y/n1 Fee Current �'/N <br /> Address <br /> License# �— <br /> MECHANICAL <br /> Signature Company <br /> Registered Y/M Fee Cur*ent Y/N <br /> Address <br /> License# � <br /> OTHER <br /> Signature Company <br /> Registered Y/N Fee Curtent �'/(� <br /> Address <br /> Directions: License# <br /> FII out application completely <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> H over$2500,a Notice of Commencernent is required(Mechanical woric over$5000) <br /> Supply two(Z)sets of drawings with appllcable documentation <br /> Allow 10-14 days for review after submittal date Parcel#-obiained from Property Tax Notice h J/a <br /> � � ttP pp2iser.pascogov.com) <br />