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oi�-rou-uvcu �,i�y oi cepnyrnius rire rax-u�s-iau-uuzi <br /> . Permit Application <br /> Date Received ' '' Phone Contact for Permit ,,,�,��, � <br /> p „ ... - _ , .. .,. , . ,... , . ., . ,» <br /> Owner's Name <br /> +E?��l� ��/N� ��t s�� � Owner's Phone Number � � � <br /> Owner'sAddress ' �7�0� /7i"IG /� J/ V✓A" /"� �T ���'�'�'S � �� � <br /> \ ��� �g� �� <br /> Fee Simple Titleholder Name Titleholder Phone Number �p <br /> Fee Simple Titleholder Address <br /> F :?�" 'g� " - - -._ , , , . , �zri:.. ,,.x. .. , <br /> Job Address ,.��� �i%E�� 'S% �'v� ����«��L� '�C H33S'`,� Lot# � <br /> SubDivision MeRR�� Po�� /��Rr'�o�% Parce�# o� ��q�U�U��aQ� d <br /> & ,-.a:,�r _ .. _ . ..-:,�:., _�: ,. , . • '"»,',�'__`"'�'�.��a ,_ ... • .. ., ,_ �_ . <br /> aBio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw Q LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale <br /> oFire Protection Maintenance-ANNUAL Places of Assembly-ANNU <br /> �y emi �n er �� �� <br /> Sprinkler � ❑ ❑ O � Recreational Bum ` <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers / <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installatio�s --.. <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> a Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> Contractor Company Ie /�fr'� <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 Current 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&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. Parcei#-obtained from Property Tax Notice(http:/lappraiser.pascogov.com) <br />