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t��� <br /> o.o-�o�-vv�� �,�n�r,L�., �,i�y��cepnyrnuis rire r8X-tS1J-/tSU-UUY1 <br /> �� � <br /> _ • , Permit Application <br /> Date Received � � �� Q 7��� //� ' � 3� <br /> � Phone Contact for Permit �.� <br /> Owner's Name L:�S� '� Owner's Phone Number ,3�3 S�! 3,S <br /> Owner's Address ��I�a� �'�.�� ��i� � �� 33�'�� <br /> Fee Simple Titleholder Name Titleholder Phone Number C� C� � <br /> Fee Simple Titlehoider Address <br /> t� <br /> r , � .,,r � .� ., <br /> . .- .rtr�..; ,.. {M:�. ..�-.. _ <br /> Job Address ,�V/��/V�� �r�.'� ,j� � ��f�, Lot# �� <br /> Sub Division Parcel# <br /> � r- _ .. ,;.�s:-_ <br /> , . _, �,�•�- : _ � � <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent [ µ` A ,y <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controiled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale ` <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembiy-ANNU <br /> ❑� emi � er <br /> Sprinkler ❑ ❑ ❑ � � Recreational Bum '1 � <br /> � �� /` <br /> Fire Alarm ❑ ❑ O � � Sparklers / <br /> Hood Cleaning � ❑ � ❑ �� � Sprinkler System Installations � � <br /> Hood Suppression � ❑ ❑ ❑ �� � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> � Other: <br /> R <br /> -4 - - - ..,, >-> . <br /> Contractor � ,... ..,j s,..?<,� _._,�>r.._,�,�T _» <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> PLIJMBER <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> Lice�se# <br /> MECHANICAL <br /> Company <br /> Signature Registered Y/N Fee Current Y/IV <br /> Address <br /> License# <br /> OTHER <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> Directions: <br /> Fili out application completely <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> If 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 Pro ert Tax Notice htt //a <br /> P Y ( p: ppraiser.pascogov.com) <br />