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oi�-�ov-w�� l.11y OI Le�fly(flllt5 rlf6 rax-tsia-iau-uuzi <br /> _ . Permit Application <br /> Date Received � � Phone Contact for Permit � <br /> F . . �.. . _ . _, _ . . _ e , . ,. <br /> Owner's Name z/� L � Owners Phone Number C� � � <br /> Owner's Address ��' � <br /> Fee Simple Titleholder Name Titleholder Phone Number � <br /> Fee Simple Titleholder Address <br /> p `.,,.� r��.fi�'_- >?i t _��` `1'L=°�".``yn i i5t,".^�+'Fi='.'t�.+r_ -_ - � �., ,:d'n'!�^ ._ ... <br /> :�'�'°z;��.�.s =�z;.„,�;,:^?"?r,±�2Y';-:�.G.�'.: _ _ <br /> Job Address � � ��- � <br /> L�J <br /> Sub Division Parce <br /> R . . _ .� -i_ ._-.- : er -: _ .,. „ . a t _ <br /> ,�,:. , ,,.:... ,°.o._ _ .,_ _ ' _ ._r;o, _. ._ r.'.:aaY"_,:i'a.:r_ �. � ;:x r•?�:��--:;+->;,�a--� .�. _ , <br /> � Bio-Hazard Waste Storage-ANNUAL�g � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ 1=acility)ANNUAL <br /> aControlled Burn � Hood Installation <br /> � Emergency Generator<30 kw a LP/Natural Gas-Installation <br /> � EmergencyGenerator>30 kw LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL � <br /> ❑�y emi �n er ------� <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � a 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 /> aFlammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> � . _ ._, -I .. - -, __ ' ' = � . s... s . ' _ ,... .A._ _., _ _ - {x, <br /> Contractor ' / ,- Company <br /> Signature �/ Registered Y/N Fee Curre Y/N <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Company <br /> Signature Registered Y/N Fee�urrent Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee�urrent Y/N <br /> Address <br /> 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 Commenceme�t is required(Mechanical work over$5000) <br /> Supply Mro(2)sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submirial date. Parcel#-obtained from Property Tax Notice(http://apprareser.pascogov.com) <br />