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oi�-iov-�v�v �,iiy oi cepnyrnms rire r8X-t5lJ-/tSU-UUY"I <br /> Permit Application <br /> Date Received"` � Phone Contact for Permit � � � <br /> C , �.. ,- ... . 9_3i T <br /> Owner's Name • �E�, Owners Phone Number � � � <br /> Owner'sAddress • / `Ly2.. /�LL 1� . �F� �1-�-5 <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> 1- _ ,- �) .. , .- � - - . _ :.r_.� _ T.�y;, p,�:.fi.�_a° . - , <br /> Job Address Lot# � <br /> Sub Division Parcel# <br /> � , , .�, . ..,,��.:�-, _� ,�. .� � - �..„�,��� .� . :.�;�:,�;::;�a_=�:;�.� � � - <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 � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> aEmergency Generator>30 kw LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL �Places of Assembly-ANNUAL <br /> � emi � er <br /> Sprinkler � ❑ ❑ ❑ � Recreational8um �/ (��3� <br /> / <br /> Fire Alarm � ❑ ❑ O � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation a Torch Roofing/Tar Kettle <br /> a Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> aFuel Tanks <br /> Q other: <br /> �. _ _ ,t = , ., w .. ,.�. �.-� ;,-_, _ <-. ......,.,_ a.._ ..;.�_,� __ -Y.=���a}.,. t � _ <br /> Contractor Company <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 /> s <br /> Directions: <br /> Fill out application completely <br /> Owner 8�ContraCtor sign back of application,notarized(Or,copy of signed contrect 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 />