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� ' o�o-�o�-�v�� �,iry vi�epnyrnws nre rax-ais-iau-uun <br /> Permit Application <br /> Date Received -� ,t0� G)z/�'�/1/r Phone Contact for Permit $j 3 �lf 93.� <br /> /`T <br /> Owner's Name ��s2l.a 7�{��V j`�]_� � <br /> Owner's PhoneNumber 8 f 3 S�5 �35� <br /> Owner's Address �Q• �O.� �/�� f�M��� �L 3 3 6 �Lf. <br /> Fee Simple Titleholder Name Titlehotder Phone Number � C] � <br /> Fee Simpte Titlehoider Address <br /> t� <br /> Job Address _ �i���.�„�X �'�� �Q�� ��� �L U,(>� -� Lot# � <br /> Sub Division Parcel# <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/0uct � Hazardous Materia!(Tier II or RQ Facility)ANNUAL <br /> aControlled Bum � Hood Insialtation <br /> � Emer9ency Ge�erator<30 kw Q LP/Natural Gas-Installation <br /> aEmergency Generetor>30 kw � LP/Natural Gas-ANNUAL Sale <br /> QFire Protection Maintenance-ANNUAL � Places of Assemb(y-ANNUAL <br /> ❑ 3fTr y emi � er - <br /> Sprinkler ❑ O ❑ � Recreational Burn / <br /> Fire Alarm � ❑ ❑ O � Sparklers 9 5��v <br /> Hood Cleaning � ❑ � ❑ �� � Sprinkler System Installations / � <br /> Hood Suppression � ❑ ❑ p �� � Standpipes(Sprinkler Sys) <br /> � Fire Alarm installation � Toroh Roofing(far Kettle \`" <br /> o Fire Pumps � Waste Ti2 Storage ANNUAL <br /> � Fire Worics <br /> � Flammable Appiication-ANNUAL �--_� Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> �ontractor ����� Compa"y ��/E S S - <br /> 3ignature Registered Y/N Fee Cu►rent Y/N <br /> Address <br /> License# <br /> _LECTRICIAN Company <br /> iignature Registered Y/N Fee Current Y/N <br /> Address Ucense# <br /> 'LUMBER Company <br /> iignature Registered Y/N Fee Current Y/N <br /> Address License# <br /> AECHANICAL Company <br /> iignature Registered Y/1�) Fee Current Y/N <br /> Address <br /> License# <br /> )THER <br /> Company <br /> tignature Registered Y/N Fee Current Y 1 N <br /> Address <br /> License# <br /> iirections: <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 wilh applicabie documentation <br /> Aliow'10-14 days for review after submittaf date. Parcel#-obtained from Property Tax Notice(hripJ/appratser.pascogov.com) <br />