Laserfiche WebLink
o�o-,��-���� �,nyoi �epnyrnuis rire rax-ui,s-itsu-UU[� <br /> • ' Permit Application <br /> Date Received � �� �� ��,2,�1 f,� Phone Contact for Permit �3„ �If 9,35� <br /> f <br /> Owner's Name � lJLJ� �7�j� Owner's Phone Number ��3 .��f /3s <br /> Owner's Address (r C1. �/�� �7�j t3 <br /> Fee Simple Titlehoider Name Titleholder Phone Number �� �� � <br /> Fee Simple Titleholder Address <br /> e � .� : , _ - . _ <br /> Job Address L-� � �/V L Qaj�/�U�`> Lot# �� <br /> Sub Division �V � �L� �j�VU. Parcel# <br /> ` � ' ' "� - — ° , _ , <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent� <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> aControdled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � L�/Natural Ga�-�41vi�UAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> �y ' emi �n er �� � <br /> Sprinkler � ❑ ❑ ❑ B � Recreational Bum �' 1i'- � �S <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers ` <br /> Hood Cleaning � ❑ � ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> a Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> QFlamm�ble Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> ° ' � .- _ . <br /> Contractor Company (/1 / y� , �' � � <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> 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/I�I <br /> Address <br /> License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> Directions: <br /> Fill out application completely <br /> Owner&Contractor 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 submittal date. Parcel#-obtained from Property Tax Notice(http:/lappraiser.pascogov.com) <br />