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o�,-,ou-w�� ,ity oi �epnyrrnus rire rax-uis-iuu-uuz� � - Permit Application Date Received Phone Contact for Permit � � � Owner's Name j-�u �T I1 �S ��/p q tJY C Owners Phone Number ��/,3 7/[f ,3�Z� Owner's Address ,/� d� � S� � , Fee Simple Titleholder Name Titleholder Phone Number C� �� I I Fee Simple Titleholder Address �-� r i Job Address Lot# � Sub Division Parcel# ° i , .- � Bio-Hazard Waste Storage-ANNUAL � Fumigation TentA � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or R�Facility)ANNUAL aControlled Burn � Hood Installation � Emergency Generator<30 kw � �P/Natural Gas-Installation QEmergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL ❑ ry emi � er ❑ �� Sprinkler ❑ ❑ ❑ Recreational Burn �lL ❑ � ❑ .� ( � Fire Alarm ❑ ❑ ❑ Sparklers Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) � Fire Alarm Installation � Torch Roofing/Tar Kettle � Fire Pumps � Waste Tire Storage ANNUAL � Fire Works � Flammable Application-ANNUAL � Valuation of Project Fuei Tanks Q Other: " � _ _ R - Contractor " ' ° � � Company Signature � Registered Y/N Fee(:urrent Y/N Address License# ELECTRICIAN Company Signature Registered Y/N Fee C:urrent Y/N Address License# PLUMBER Company Signature Registered Y/N Fee C:urrent Y/N Address License# MECHANICAL Company Signature Registered Y/N Fee Current Y/N Address License# OTHER Signature Company Registered Y/N Fee Current Y/N Address License# Directions: Fill out application completely Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) If over$2500,a Notice of Commencement is required(Mechanical work over$5000) Supply two(2)sets of drawings with applicable documentation Allow 10-14 days for review after submittai date. Parcel#-obtained from Property Tax Notice(http.pappraiser.pascogov.com)