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a��-�o�-vv��� �.ity oi cepnyrnms rire <br /> rax-ui a-itsu-UU[� <br /> P rmit Application <br /> Date Rece�d�ed � .• �� � /�0�,3 Phone Contact for Permit p�3 ,j�fs" �'f 3s� <br /> a 1 � � � <br /> Owner's Name �-S��C� Owner s Phone Number ��3 �Lfs q 3 S/ <br /> Owner's Address • Q. ��/C 1 7 d �f�M�� �� `�6 7� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� U �� <br /> Fee Simple Titleholder Address �--���� <br /> ��� .,, r �... ..�.. .� ,y; r� =-;:�" :_�,.._ - ,:.�:� .. <br /> 2 _.�s,,, .x_. <br /> JobAddress J�' �R�� �j�,l`� �aQg G�C/ T7IIfD. � <br /> L ���'B Lot# <br /> Sub Division <br /> R Parcel# <br /> .;.a� ,»=�>:��<::, � , � . .. � <br /> � . , °.. _ .- �s3 r.�r�� .. ., ,-_-• :.�4,:> «�,�r- ., x <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-Instalfation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> ❑ r y emi � er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum ,f�� ! > <br /> Fire Alarm �r <br /> � � � �� � Sparklers � � <br /> Hood Cleaning (� ❑ � � � <br /> � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ C� � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Instaliation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � FlammableApplication-ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> � <br /> Q Other: <br /> - ° - �. : . . -- .�. _ - <br /> Contractor � � .� ...._:_ ,� ..-�� _ .,:�.�:,:��.__.4 _, - <br /> Signature <br /> Company � s <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> ELECTRICIAN <br /> Signature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Signature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address � � <br /> License# <br /> MECHANICAL <br /> Signature <br /> Company <br /> Registered Y/N Fee Current 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 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 submittai date. Parcel#-obtained from Property Tax Notice(http:!/appraiser.pascogov.com) <br />