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o�o-�ov-w�u �,iiy oi cepnyrnws rire rax-ais-�tsu-uuzi <br /> �Q�{ Permit Application <br /> Date Receiw:d �p��/�:3 J' <br /> � Phone Contact for Permit � S'7.5 �J�J l <br /> Owner's Name r �jo� � Owner's Phone Number S�c� ���f 9,��j <br /> Owner's Address T* �. �(J.� 9•7� ��� � �L 3 � �� <br /> Fee Simple Titleholder Name Titleholder Phone Number C� C� �� <br /> Fee Simple Titleholder Address <br /> ' � " - . �-. , a - � <br /> Job Address �� � � �� Lot# � <br /> Sub Division �V ('��C�� b L yL.� Parcei# <br /> ` r _ ,� t , _,4..� <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 /> QEmergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw a LP/Naturel Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> r y emi �n er <br /> Sprinkler � ❑ ❑ O � � Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ � � Sparkiers / �- / � <br /> Hood Cleaning � ❑ Ci' � Sprinkler System Installations ( � <br /> � � f <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 /> � FlammableApplication-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> ' ' - ' - <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 Current Y/N <br /> Address <br /> 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 Curtent Y/N <br /> Address License# <br /> OTHER <br /> Company <br /> Signature Registered Y/N Fee Cunent Y/N <br /> Address License# <br /> Directio�s: - <br /> Fill out application completely <br /> Owner 8 Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> If over$2500,a hlotice of Commencement is required(Mechanical work over$5000) <br /> Supply Mro(2)sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcei#-obtained from Property Tax Notice(http:qappraiser.pascogov.com) <br />