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<br /> Permit Application
<br /> Date Recaived `� ' Phone Contact for Permit �����-�-► � I
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<br /> Owne�s Name ^ Owners Phone Number � � �i�
<br /> Owneds Address
<br /> Fee 3(mple T(deholder Naroe 'fiUeholder Phone Number �,� � �
<br /> Fee Simpte TiUeholder Address
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<br /> '°'$�.22:.;'1E''_'_�'^:���i-�,�.�_��:�Sn 5:.�'�S:7-v�=,'E;; _ " ' - ':s_;F:__r.� ,...=%;-g's^�'_'::'..,.cc,:7�3, �r:.r.'f.iS
<br /> Job Addresa � - - —-- - - - - - ----- ----- -- - - -- Lot# �
<br /> Sub Divtsion Parcel# �
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<br /> _�,•�-r=:c:3,._...ew ��.�sx?:3._#;:u*i�,st�?'^".F'1'kf3f';it:;7!:��=��=�_. ,-_'-;�=�-_,,.,�.---�-��r— �-__----_ --_::.'s;f��..t-..�.;f�.i.L;x�.e,::...,..��^3�,sr3��.;_..=.-�?�"tii;��x�a
<br /> a BlaHaza►d Waste S{oraga-ANMtfAL � �umfgaUon Tent
<br /> a Comm Exhaust Kltchen HoodlDuct � iiazardous Mateda!(Tier!i or RQ Fac�lity)ANNUAI.
<br /> � o Controllad Bum � Nood InsiallaUon
<br /> oEmergency Gsneralor<3Q kvi a LPlNatural Gas-InstalfaUon .
<br /> � Emerg�ncy(3enerator>3�kw � LPlNatura�Gas-ANNUAL Sale
<br /> � Fire Protectfoo Maintenence-AtJNUAL Q Piaces of Assembfy-ANNUAL .
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<br /> S rinklar � ❑ ❑ O � Recreatlonal fiurn -— ------ - - - -- —
<br /> Fire Alarm ❑ � � � � Spartcters
<br /> Hoai Cieaning � ❑ O O � � Sprinkler System insialla6on5
<br /> Hood 8uppreasion � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) ,
<br /> � Fire 1liarm Installation � Torch Roofing/7ar Keflle
<br /> Fire p�ttnps a Weste 71re Storage ANNUAL
<br /> Fire Works
<br /> Fiammabis Application-ANNUAI �—� Vaiva#fon of Pro)ect
<br /> 0 �.
<br /> Fue!Tanks
<br /> � oiher:
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<br /> 1sb�:i:�.`1�'s:�3?�!''l:.^^„k',i;:rd!S�°-?.�',-:�:ar,F;:i�i_�;'rL�_-...>r.,,.,�,o...,_.�'��c!ic..x.r�.n.�,....... ........, ..«....__. .:-r ii ., :-i•..-�.,. .- :..._ :iz�z'.�S:�.k....�tii::i�:;t�.`�+:i:-,o?�F7:;., t�,.=r`�3a.i1:�'-�iia..ar3:�5
<br /> Contractor Company �
<br /> Signature Regfsteted Y/N Fae Curcent /
<br /> Address �� Llcense#
<br /> EI.ECTRICIAN Company
<br /> Signature Reqistered Y/�I Fee Current Y 1 N
<br /> Address i.fcense# '
<br /> PLUMBER Company
<br /> 3ignature Reg3siered Y/N Fee Current Y/N ' '
<br /> Address License# �— ,
<br /> MECIIANICAL Company �
<br /> 5isnature Reg(stered Y/N Fea Current Y/!�! ,
<br /> Address Ltcense#
<br /> OTH�R Company ' � �
<br /> S[gnature itegistered Y/N Fee Cu�enf Y/IV �
<br /> Address Ltcense# r—
<br /> ,�. _i:, »..::_.: �..,.s__,n:_. - _,�rr.J..:...._.:--�_—��_.r-•:r..�exs-_.'____.Liii�'°.�. ��...�,.. _ , .. .._ �'�1�st•;'i�:x•.t;�
<br /> DlrectlOnS: '
<br /> Fill out applicetlon complelely.
<br /> C)wner&Corttractor sign back of applicatlon,nofa�ized{Or,copy of signed contract with owner)
<br /> If over$2500,a NoBce ot Commencement is requtred(Mectianical work over$5000)
<br /> Suppty hvo(2)sets of drawtngs wlth appitceble documenlaUon
<br /> Allow i0-14 days tor revle�v afler subm[ltel date. Parcel#-obtained irom Property Tax NoSice(httpJ/appraiser.pascogov.com)
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