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6'J-/OV-VUL'J
<br /> �,ny oi cepnyrnms rire rax-ai,s-iau-vuz�
<br /> Permit Application
<br /> Date��eceived• • '7Tdl� �1��� '�/f Phone Contact for Permit �� �jys' 93s�
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<br /> Owner's Name �//��C�Q � ��T� pwner's Phone Number 8��� S/�S !�J?JC�
<br /> Owner's Address �V, �O q��� ���� fG 3 J?�,,(�
<br /> Fee Simple Titleholder Name Titleholder Phone Number � �_ I �
<br /> Fee Simple Titleholder Address J �J
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<br /> Job Address �0/���C/� ���jQ �� ������ ����,
<br /> Lot# �
<br /> Sub Division
<br /> F , " . . ,«-...:. .
<br /> Parcel#
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<br /> � . . . � ��� "' '�' ���� _ ,.',L _v'S� e "rie� .'. ._
<br /> Bio-Hazard Waste Storege-ANNUAL � 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
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> ❑ ry emi � er �
<br /> Sprinkler ❑ ❑ ❑ Recreational Bum
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers �
<br /> Hood Cleaning f� ❑ � ❑ C� ❑ SprinklerSystem Installations �����
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle
<br /> aFire Pumps a Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Application-ANNUAL
<br /> aValuation of Project
<br /> Fuel Tanks
<br /> QOther:
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<br /> Contractor �o?p � Company , " /G C�S� S�R 1�%CES
<br /> Signature �—:��o
<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 />�THER
<br /> 3ignature
<br /> Company
<br /> Registered Y/N Fee Current Y/N
<br /> Address
<br /> License#
<br />)irections . :
<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 lwo(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)
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