Laserfiche WebLink
�-�ov-uu�u �,iry oi cepnyrruus rire rax-tsi,s-itsu-vU[i <br /> � Permit Application <br /> `Dat�ReceiveG �Z-� -- /t / ��p� L� ` Phone Contact for Permit � � � <br /> d<< <br /> � — � <br /> Owner's Name -�.Q ° /1 j Owner's Phone Number �� ��� ��j�� <br /> Owner'sAddress ���- /�i��C`� �- �v� �� �G 3 � <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> E .� . � x , s - ,_ <br /> Job Address J 3� T�- Z�' (il���l � �Li Lot# � <br /> Sub Division Parcel# <br /> b " . _ ' _ .. - ._ .�. _ � . ._„ _ —_, _. .__ � �., � <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent3 <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier 11 or RQ f=acility)ANNUAL <br /> � Controlled Burn � Hood Instailation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw a LPlNatural Gas-ANNUAL Sale �-----'""—�� <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL �,,%' <br /> � emi �n er � <br /> Sprinkler � ❑ O � � Recreational Bum /� <br /> i <br /> FireAlarm • � ❑ ❑ ❑ � � Sparklers ,� � <br /> Hood Cleani�g � ❑ ❑ ❑ � � Sprinkler System Insta}I�ations �� <br /> f .� l� <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(SprinklEr Sys) � <br /> � Fire Alarm Instaliation � Torch Roofing/Ta `Kettle <br /> � Fire Pumps � Waste Tire Stora�e`ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q other: <br /> Contractor Company �d.� a � c !� <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 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 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 8 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 submirial date. Parcei#-obtained from Property Tax Notice(http://apprarser.pascogov.com) <br />