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o�o-�ou-uvcu �.ny oi cepnyrnws rire rax-uis-itsu-uuz� Permit Application Date Received �"�� E_� I Phone Contact for Permit � � � FOwner's Name ' e. l �f�'� Owner's Phone Number � � � Owner's Address Fee Simple Titleholder Name Titleholder Phone Number � �� Fee Simple Titleholder Address b Job Address � 1 � . �1 � I �/y Lot# � Sub Oivision Parcel# _ _ . � ,t � - - — aBio-Hazard Waste Storage-ANNUAL � Fumigation Tent � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL � Controlled Bum � Hood Installation � Emergency Generator<30 kw LPlNatural Gas-Installation Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale � � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL / [�z � �y emi �n er � I —1 J Sprinkler � ❑ ❑ ❑ � � Recreational Bum Fire Alarm � ❑ ❑ ❑ � � Sparklers Hood Cleaning � ❑ ❑ ❑ � � Spnnkler System Installations Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) � Fire Alarm Installation � Torch RoofinglTar Kettle a Fire Pumps � Waste Tire Storage ANNUAL � Fire Works � Flammable Application-ANNUAL Valuation of Project � Fuel Tanks Q Other: Contractor � ' Company a.r� r�"i Signature Registered Y/N Fee Current /N Address License# ELECTRICIAN Company Signature Registered Y/N Fee Current Y/N Address License# PLUMBER Company Signature Registered Y/N Fee Current Y/N Address License# MECHANICAL Company Signature Registered Y/N Fee Current Y/N Address License# OTHER Company Signature Registered Y/N Fee Current Y/N Address License# � Directions: Fill out application completely Owner 8 Contractor sign back of application,notarized(Or,copy of signed contract with owner) If over$2500,a Notice of Commencement is required(Mechanical work over$5000) Supply two(2)sets of drawings with applicable documentation Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)