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o�o-�ov-uv�v l..11y UI L@�fly�(11115 rlf@ <br /> r8X-2S l,i-/tSU-UU'Ll <br /> Permit Application <br /> Date Received � 7/�,'�� l� g 3 �� q 3s <br /> ' Phone Contact for Permit <br /> Owner's Name L- ��� � � � Owner's Phone Number �� ,S�s �'3„� <br /> Owner's Address � V� �jQ �7�3� �-� ��Q -�L 3 3 6 7� <br /> Fee Simple Titleholder Name Titleholder Phone Number � � �� <br /> Fee Simple Titleholder Address �----�� <br /> G�(.D� l� �'�l I�D�4 � - . � ,:-�. �. ._ �_ ��,�.: - :�., - , .. <br /> Job Address 3 7 q 15 ���7�IV !y�U�, �� <br /> Lot# <br /> Sub Division <br /> Parcel# <br /> ° '' - - - ,_ _ , � <br /> � A } _.. _ .'�'_;..k_^ '. . ".t .i-"o-Sav'4'1°t'i.Bt:f_6 .- <br /> Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � 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 Assembly-APINiJAL ' <br /> ❑� emi � er ❑ - <br /> Sprinkler ❑ ❑ ❑ Recreational Burn } � <br /> Fire Alarm L� �" <br /> ❑ / � � � � Sparklers /�7 ��1� <br /> Hood Cleaning � C/ O ❑ � <br /> C� � Sprinkler System Installa ons <br /> Hood Suppression � ❑ ❑ ❑ � Standpipes(Sprinkler Sys) <br /> a Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � FlammableApplication-ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q other: <br /> ` � - , � -- _. . , .�. . , <br /> Contractor ° _ �. „ :��,-.;,,,�� �. . ,��,. � _ . <br /> Company (� �'� � <br /> Signature Registered Y/N Fee Current Y/N � <br /> Address <br /> License# <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Signature <br /> Company <br /> I Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> MECHANICAL <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> OTHER <br /> Company <br /> Signature Registered Y/(V Fee Current Y/N <br /> Address <br /> License# <br /> Directions: <br /> Fill 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 Property Tax Notice htt !/a <br /> ( p: ppraiser.pascogov.com) <br />