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o�o-�oU-��,��� �,iiy oi cepnyrnws rire <br /> rax-�i a-iau-uun <br /> - Permit Application <br /> Date Received �—ly — ,����� Phone Contact for Permit �� � � <br /> —��� <br /> Owner's Name ��,.z,� {� Owner's Phone Number ��� � '� �3�� <br /> Owner's Address y�,�+I� ��,� „�"L a3�/ � <br /> ►" J ID <br /> Fee Simple Titleholder Name Titleholder Phone Number C� �� � <br /> Fee Simple Titleholder Address � ��� <br /> F �.,....__-,- ____.__.. <br /> �""�`_, _ , c. �� ; - , <br /> JobAddress - 1 //� �14L(, `v +� Z� �, �iy�� S � 33S �/ � Lot# <br /> - _ — �--- �� <br /> Sub Divisi —�--'- <br /> Parcel# <br /> F . _ __ - :.- ,�.-. <br /> � - __ -_ - - - � , , �,_ ' <br /> Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er ' //") �� <br /> � � 4� < < <br /> Sprinkler ❑ ❑ � Recreational Burn ( <br /> Fire Alarm � ❑ ❑ ❑ S arkl <br /> ❑ � � p ers <br /> Hood Cleaning ❑ p � � ❑ �� <br /> Sprinkler System Installati ns <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 /> , _ .. . � . .. r _ -.� , _ - '.3 <br /> COf1tf2CtOf - ��� - -" ` _ . , <br /> Company ��Z.y. pv� ��Qc <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y/N Fee(;urrent Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Company <br /> Signature Registered Y/N Fee C:urrent Y/N <br /> Address <br /> License# <br /> MECHANICAL <br /> Company <br /> Signature Registered Y/N Fee Gurrent Y/N <br /> Address <br /> License# <br /> OTHER <br /> Signature <br /> Company <br /> 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 contrect 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 htt //a <br /> ( p: ppraiser.pascogov.com) <br />