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610-'��-w�" �,uy oi �epnyrnms rire rax-ts�.s-iau-uun <br /> Rermit Application <br /> Date Received — — � Phone Contact for Permit j �� �f f(p <br /> 6 • - .,._w�. ,_. , _... ,. ,.... . , w -.. �.. �_ . ...... .. .. . .. . . <br /> Owner's Name p Owner's Phone Number C� �� � <br /> Owner's Address �j � �?I��[,Z <br /> �-v i- <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� �� <br /> Fee Simple Titleholder Address <br /> p: .. , �..t« £;r�-�&,*�`�`a�.�.+,�'-e�o-'�,*.^ �.'.'f�;S�4�;'.;r�' S;.�.�:'� . °"E.s+,�-.� -e�� M. <br /> - _ ?.?� �,.*!'g;,'w';a�-�-�F''2`.s,��.-.: _ ,. _�..=r - . <br /> Job Address � � ,�, � --�_�. Lot# �� <br /> r <br /> Sub Division Parcel <br /> � * . - , .x .�,.,y�n.„: , _ _ .��t-.-�:��x,�w._.�:.e<.- ��xs_ -_ , • ._�.».�.�'s.�. _..�.,. ._ »;d�-a#r��-,;�r�.=-,�.�°�>,...��;:==�A..t;±..sae��:�.,, :#,e� <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation,Tent € u` .y <br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier I�or RQ Facility)ANNUAL <br /> aControlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> aFire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL ,/��y� <br /> �y emi �n er � 1� r C�, v <br /> Sprinkler � ❑ ❑ ❑ B � Recreational Burn � <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � 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 Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> '� ' - —' � _ s�. .e. _ v °'T.:. yar ` _ a _ _ ' ' ... ,.,}rt.n _ "__n.r..-_ , ., <br /> Contractor ' <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee CuRent Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Company <br /> Signature Registered Y/N Fee CuRent Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER <br /> 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 /> Aliow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http:/lappraiser.pascogov.com) <br />