Laserfiche WebLink
o�o-�o�-w�� �,ny oi cepnyrnms rire rax-a�a-itsu-uuz� <br /> Permit Application <br /> Date Re�eived „ �Q, (iI�'1 � '3 x` - ' <br /> k .� Phone Contact for Permit $�� S�f 93S'� <br /> Owner's Name �i�S2� �QV�j r� Owner's Phone Number 8�3 Sy�S 93,�5/ <br /> Owner's Address �Q. ���1 /7�� �T7/ ��� / L 33�j7 <br /> Fee Simple Titleholder Name Titleholder Phone Number � �� � <br /> Fee Simple Titleholder Address <br /> �"__ - ^.�.�,..: :t�-����s��°.�����:t��-x�. ,,. , <br /> ,i°^f;'..'>A�.;9�.�`wC:r?Y..i '.?A,,}. �:�;sm �..,.i`.-.. : .�� .. , <br /> Job Address �JTT R� �C,��1��'�j/�/ S /'� `j7¢L,� �V,�, Lot# �� <br /> �J <br /> Sub Division Parcel# <br /> w , _ Y.kR� .�.,�m.��.,,..:., _. 3,. F , � , ��*u_�s�.K.x,�. ,. :•� �r:,.,-�: .--� .:� <br /> � Bio-Hazard Waste Storege-ANNUAL t � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> aControlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> ❑�y emi �n 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 a Torch Roofing/Tar 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 /> Contractor c✓%.�E�'�-�'�'r� Company � Y'� :.S . .. .....,�- ,.,G��' - <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> ELECTRICIAN <br /> 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 Current Y/N <br /> Address <br /> License# <br /> OTHER <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> 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://appraiser.pascogov.com) <br />