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oio-iov-�v�v �,iry�i �epnyinnis rire reX-tSl3-/25U-UUY"I <br /> ' ' � Permit Application <br /> Date Received � �Ul�. �� I.Z-7��� Phone Contact for Permit g��� .s�{� �{3S� <br /> Owner's Name L��J z (/' Owner's Phone Number �.3 S�.S �3 S <br /> Owner'sAddress ��.p�/� //J� /�/"/�� �� �JC7�1f' <br /> Fee Simple Titleholder Name Titleholder Phone Number C� � � <br /> Fee Simple Titleholder Address <br /> � . ,,. . � ..- . , . <br /> e. <br /> Job Address � / ���/N V!V� /V(,j� J� �//J G��C� 2�/,�4'�� Lot# � <br /> Sub Division Parcel# <br /> � _ . , � _ _ ._,_ ., ,, . ; <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> aControlled 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 /> ry em� �n er �� � <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum � <br /> Fire Alarm � O ❑ ❑ � � Sparklers � <br /> Hood Cleaning ❑ � ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> aFire 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 Othef: <br /> Contractor ' / Company / s�� S' yQ /G� <br /> Signature �"�-�' Registered Y/N Fee Current Y/N <br /> Address Lice�se# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> s <br /> Directions <br /> Fill out application completely. <br /> Owner 8 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 submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />