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or�-�ou-w�u �,iry oi cepnyrnnis rire rax-a�e-iau-uuz� <br /> Permit Application <br /> Date Received " Phone Contact for Permit <br /> � _. ,.._.� - . .... , - ,. �._ . � _ . �F . <br /> Owner's Name � Owner's Phone Number � � � <br /> Owner's Address Fj� [ <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> _.�.�,n. ..,.�-�,�.,,.... �.,.... ....�. -„�,..;�, <br /> r _ i, _...r �s�m:..>. :��_:�€..., ��a,.,:,..,< .: -_.:n��- - ^�,^�.� ;x., .. � <br /> ,.:�-�,. ��'�c;i�:r�.>�=s:r�r.�:; _ f.�.� - <br /> Job Address Lot# � <br /> Sub Division Parcel# <br /> � _ . ,..-"M1`�.�.tSAEP'.��e: i,,.�A�C�a- _`."�F"-^ -,E_. _ -,. _ , e.: " _ _,...KS.F_ _... a`s!AUesr�,.- - . W,;-ys». .-. �+l,`_N+4 v �#-..a_ . <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier 11 or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Instaliation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale / <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNU �lQ� <br /> �y em� �n er ��'� <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning �� ❑ ❑ � ❑ Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ � � Standpipes(Sprinkler Sys) � <br /> � Fire Alarm Installaiion a Torch Roofing/Tar Kettle <br /> ciC. � �`� <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � FlammableApplication-ANNUAL Valuation of Project <br /> aFuel Tanks <br /> � ot r: <br /> � - � -3 - - _ , .: ,_- - ,.s .a _ . ` - _ . -_._..,. _ _ <br /> Contractor Company � (Vl <br /> Signature Registered Y/N Fee Current Y/N �'� <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Curcent Y/N <br /> Address License# <br /> OTHER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> Directions: <br /> Fill out application completely <br /> Owner 8 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(http.//appraiser.pascogov.com) <br />