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o�:,-,o�-vu�v l.11y UI L6�f1Yff11115 rlf@ rax-aia-itsu-uuzi <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> k ' ^'1 , .-,._ . �.� ,.... .�-�.- � <br /> Owner's Name ,fj,p ��.�. �¢ ,� Owner's Phone Number �� � �� <br /> Owner's Address �jj,��L �L� � / <br /> Fee Simple Titieholder Name Titleholder Phone Number C� C� � <br /> Fee Simple Titleholder Address <br /> u <br /> E i , . . <br /> Job Address �� <br /> Lot# <br /> Sub Division Parcel# <br /> e t " '' t i <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent � <br /> a Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Ge�erator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> aFire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> ❑� emi � er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ � ❑ � � Standpipes(Sprinkler Sys) <br /> aFire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> aFuel Tanks <br /> Q Other: <br /> ° � � .. <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�urrent Y/(V <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee C;urrent Y/N <br /> Address <br /> License# <br /> OTHER <br /> Company ,�C� <br /> Signature w�,-� Re istered ` <br /> 9� Fee CuRent N <br /> Address 7pJ Ota/L F�qc �^ <br /> �L• License# <br />.Directions: <br /> Fill out application completely <br /> Owner&Contractlor 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 />