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o�o+�o�-�u�� �ny oi cepnyrrnns rire rax-�s�,s-iau-uuzi <br /> Permit AppliCation <br /> Date Received ;:��, Q� 2 'f'1 Phone Contact for Permit �� �_;_Ls2.l �� .� <br /> / "7 <br /> Owner's Name S�(„ • Owner's Phone Number O�� .��S q�s� <br /> Owner's Address ��1 BOX �73 !f�l��Pf1 �L 33 'T <br /> Fee Simple Titleholder Name Titleholder Phone Number C--� C� � <br /> Fee Simple Titlehoider Address <br /> Job Address ���(� � ���� ���s �`��� �L�� '1 lot# � <br /> Sub Division Parcel# <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent ' <br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier li or RQ Facility)ANNUAL <br /> aControiled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LPlNatural Gas-Installation <br /> � Emergency Ge�erator>30 kw � LP/Naturai Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> ❑ (3f�r y emi ��r" ❑ <br /> Sprinkler ❑ ❑ Q Recreational Burn � <br /> C� ❑ � f � <br /> Fire Alarm ❑ ❑ ❑ Sparklers i � <br /> Hood Cleaning ,J� O ❑ C� � Sprinkler System Installations <br /> Hood Supp�ession � O ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm installation � Torch Roofing/Tar Kettle <br /> Fire Pumps Q Waste Tire Storage ANNUAL <br /> Fire Worics <br /> Ftammabte Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q �th6f: <br /> �ontractor � Company <br /> iignature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> =LECTRICIAN Company <br /> �ignature Registered Y/N Fee Current Y/N <br /> Address License# <br /> �LUMBER <br /> Company <br /> iignature Registered Y/N Fee Current Y/N <br /> Address license# <br /> AECHANICAL Company <br /> iignature Registered Y/N Fee Current Y/N�— <br /> Address License# <br /> )THER Company <br /> �ignature Registered Y/N Fee Current Y/N <br /> Address License# <br /> )irections: <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#-obiained from Property Tax Notice(http:J/appraiser.pascogov.com) <br />