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� ��.,-,�„-��<� �.iry�i tnNiryinn�5 rrt� r8X-tllJ-ftlU-WLl <br /> , Permit Applicativn <br /> Date Received �-� Phone Contact for Pertnit� (3 C_;_J y�°O� <br /> Owner's Name / n � ly� �� Owners Phone Number � � <br /> ONmers Address ✓ <br /> Fee Simple Titleholder Name TiHeholder Phone Number � � � <br /> Fee Simple Titieholder Address <br /> Job Address ✓ � ` t�� ,� �r i� ,l� ` � Lot# � <br /> Sub DiWsian Percel# <br /> oBio-Mazard Waste Storege-ANNUAL a Fumigalion Tent <br /> a Comm Exhaust Kitchen NoodlDuct Q Hazerdous Material(Tier II or RQ Facility)ANNUAL <br /> � ConVoiled Bum a Hood Instaliation 4� <br /> � Emergency Generator<30 kw a LP/Natural Gas-installaHon ° �� <br /> � Emergency Generator>30 kw a /Natutal Gas-ANNUAL Sale �r�� � <br /> aFire Protection Meintenance-ANNUAL ��Pt�ces of Assembly-� <br /> � °^i �^ � C____--._... � / <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum ��"/��� <br /> Fire Alatm � ❑ ❑ ❑ � � Sparklers � <br /> Hood Cleening � O O � � � Sprinkle�System Installations <br /> Hood Supprossion � Cl ❑ � � � Standpipea(5prinkler Sysj <br /> � Fire Alarm InstailaCwn � Torch Roofi�glTar Ketde <br /> Fire Pumps � Weste Tire Storage ANNUAL <br /> Fre Works <br /> FtammaDle Application-ANNUAL Valuation of Project <br /> QFuel Tanks <br /> Q Other: <br /> Contractor Company <br /> Signature Registered Y/N Fes Current Y!N <br /> Addrass License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Curtent Y!N <br /> Address License tt <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICAI Company <br /> Signature Registered Y/N Fee Curcent Y/N <br /> Address License# <br /> OTHER Company <br /> Signature Registe►ed Y/N Fee Curtent Y/N <br /> Address Lice�se t! <br /> Directions: <br /> Fill out application completely. <br /> Owner&Conirector sign back of application,notarized(Or,copy of signed contrect with owner) <br /> tF over$2500,a Notice of Commencemeni is rcquired(Mxhanical rw�ic over 55000) <br /> Supply two(2)sets of dravuings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained frnm Property Tax Notice(http•J/appraiser.pascogov.com) <br />