Laserfiche WebLink
o io-iov-vu�� �,ny oi cepnyrnws rire <br /> . . r2X-tll3-/tfU-UUL1 <br /> Permit Application <br /> Date Received �7 � y �3 <br /> r , , __,. ,. , Phone Contact for Permit �..� <br /> Owner's Name �� <br /> '� ��"�`" ,S S L G-� �• Owner's Phone Number 3 z�''� ��'!�� <br /> Owner's Address � (/ ��'{,�(,, j� <br /> Fee Simple Titieholder Name Titleholder Phone Number C� � �� <br /> Fee Simple Titleholder Address L�___I <br /> r .._, _ :��- -a�:. -� � � _ <br /> Job Address �� <br /> Lot# <br /> Sub Division <br /> Parcel# <br /> e � , .. , . <br /> _.,m. _ ..e.:�-._.�: >�r,. <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-Installation <br /> � Emergency Generator>30 kw � `-'��""'--�� <br /> LP/Natural Gas-ANNUAL Sale � <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> ❑ r y emi � er ❑ <br /> Sprinkier ❑ ❑ ❑ Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ C� � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installatio <br /> Hood Suppression � ❑ ❑ ❑ C� � 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 /> � <br /> Q Other: <br /> Contractor � `" <br /> Company <br /> Signature . `'y`� 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 /> Company <br /> Signature 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/N Fee Current Y/N <br /> Address <br /> License# <br /> Directions: <br /> Fill out application compietely <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(http://appraiser.pascogov.com) <br />