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o io-�ov-w�v l.11Y UI L(,-`FJflYff1111S r'If@ r8x-tl'13-/ttU-UUYI <br /> Permit Application <br /> Date Received • Phone Contact for Permit <br /> � _�- � ���� <br /> Owner's Name / �o Owners Phone Number C� �� �� <br /> Owner's Address �p�j�O,J�pO� �_ �� � r,��� � �-�S L � <br /> Fee Simple Titleholder Name Titleholder Phone Number � �� � <br /> Fee Simple Titleholder Address <br /> A � �- . �..a:- ;,.�, _ .. _ .- . . _ .:';c...r�w: �.�.a;`. .-s: ° <br /> Job Address �� <br /> Lot# <br /> Sub Division Parcel# <br /> c "' 7 �:. _-,-_.�;� ., ,;,=. - , , .,:.��..,. ,. .. , :,�� a� -, <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent H <br /> aComm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or R�1=acility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> aEmergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL a Places of Assembly-ANNUAL <br /> ❑� emi � er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreationa�Burn <br /> Fire Alarm � ❑ ❑ ❑ � � Sparkiers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � p yq� ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofinglfar 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 /> F _ __ , <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 rurrent Y 1 N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee C:urrent Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee C:urrent Y/N <br /> Address License# <br /> OTHER Company �c.'_�s�,n���,.` <br /> Signature _ �-'�-� Re istered <br /> 9' � Fee C:urrent Y <br /> Address O/ o�,�,G'iy,-,o / Gv K.- License# <br /> Directions: <br /> Fill out application completely <br /> Owner&ContracCor 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 submirial date. Parcei#-obtained from Property Tax Notice(http:/lappraiser.pascogov.com) <br />