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u�a-�uu-uu�u �iry oT�epnyrnnis rire �� fax-8�3-780-002� <br /> Permit Application '� <br /> Date Received �- �- /��' Phone Contact for Permit � � � <br /> Owner's Name O P � Owner's Phone Number � � � <br /> Owners Address <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> ri _ - � - ~ - :�,; - _ . � <br /> Job Address � � � G��� /�j�r' Lot# � <br /> Sub Division Parcel# <br /> t ., y < �. , _., _ . _ . .»__,._ -. _. . .>�.:>,=,._ .. : .. . -,� T � . <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn a Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum I/�[-{���j <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers � <br /> I �� ' <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> aFire 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 /> � _ ., . -' � - � -- t; r.^- ' -, x ,. . _ � . -. .._ _. . ., .. .-�. . _-+-. r :-. _ <br /> Contractor � Company <br /> i <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 /> k <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. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />