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o��-�ou-wc� �,ity o��epnyrnms rire rax-ts�.s-iau-uuzi <br /> Permit Application <br /> Date Received � �{� ��'f� I t j Phone Contact for Permit ;3 � 9�s <br /> F � r ... ....,F.*Fe,.,...4" . <br /> Owner's Name �"���.� �V��� Owner's Phone Number 8�3 J��f s �351 <br /> Owner's Address � �o p�^ �7+3o T{�M�� �L, 33 6 7�r <br /> Fee Simple Titleholder Name Titleholder Phone Number � �� � <br /> Fee Simple Titleholder Address <br /> E � . ... , _ �-rr --a�< �.:e�. . . - , . . - - <br /> JobAddress ��—lJ�N ��7T �7'1/,S ��L/i/v �LV� Lot# �� <br /> Sub Division Parcel# <br /> r - .3:�., q.; � <br /> ' -- � -- ' . _ , ia. �� .. ti .,�d � <br /> � Bio-Hazard Waste Storage-ANNUAL a Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> Emergency Generator<30 kw � LP/Natural Gas-Installation � /�, <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale � J l� � (�/ <br /> 0 r � <br /> Fire Protection Maintenance-ANNUAL Places of Assembiy-ANNUAL <br /> � emi � er <br /> Sprinkier � ❑ ❑ ❑ B � F2ecreational Bum <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 /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> ' - ` - � -� _ � , ,__....e .,. . __ . _.. . <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 Lice�se# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Curzent Y/N <br /> Address 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 Curre�t Y/N <br /> Address License# <br /> Directions: <br /> Fill out application compietely <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 /> Ailow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />