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I Gllllll/"�Fl�./IIVQtIVI l �� � <br /> Phone Contact for Permit ='��3 � <br /> Date Received [_� LL.�-� <br /> - � Owner's Phone Number � <br /> pavner's Name , � �S `� � <br /> Owner's Address � � 'e � � � �' _ 1I <br /> Titiehdder Phone Number L_.�.---� <br /> Fee Simple Titiehdder Name <br /> Fee Simple TiGeholder Address � <br /> Lot# <br /> Job Address <br /> Parcel# <br /> Sub Division <br /> a Bio-Hazard Waste Stwaqe-ANNUAL � Fumigation Tent <br /> Q Comm Exhaust Kitchen HoodlDud a Hazardous Matarial(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum a Hood Installation <br /> � Emergency Generator<30 kw a LPMatural Gas-Installation <br /> Qa LPMatural Gas-ANNUAL Sale <br /> Emergency Generator>30 kw <br /> � Fire Protection MaiMenance-ANNUAL �P��of��mbly-ANNUAL <br /> ❑� � �� <br /> Sprinkler ❑ O ❑ � Recreational Bum r�, f � <br /> (�i �"'i n <br /> Fire aarm � 0 O ❑ � � SParfclere � `'C <br /> Hood Cleaning � O ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � O ❑ ❑ � � SbndpiPes(SP�nkler Sys) , <br /> � Fire Alartn Installation � Toroh RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable App��cation-AN1dVAL Valuation of Project <br /> � Fuel Tanks <br /> � Other: . __ ._,.�._ <br /> ConUactor Company <br /> Registered Y J N Fee Current Y/N <br /> Signature <br /> License# <br /> Address <br /> ELECTRICIAN Company <br /> Registered Y/N Fee Current Y!N <br /> Signature <br /> License# <br /> Address ,— <br /> PLUMBER Company <br /> Registered Y/N Fee Current Y/N <br /> Signature <br /> License# <br /> Address <br /> MECHANICAL Company �— <br /> Registered Y/N Fee Curcent Y/N <br /> Signat�re <br /> License# <br /> Address � <br /> OTHER Company <br /> Registered Y/N Fee Curcent Y/N <br /> Signature <br /> License# <br /> Address <br /> Directions: <br /> Fill out application completely. <br /> Owner&Contractor sign back of application,notarized(Or,copy of sig�ed conUact with owner) <br /> If over$2500,a Notice of Commencement is required(Mechanical work over$5000) <br /> Supply two(2)sets of drawinys with applicable documentatio� <br /> Atlow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br /> i <br /> i <br /> I <br />