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_ � <br /> � <br /> o�a-�o�-uv�� �i�y���e nyrnius rire rax-uie-�au-uuz� <br /> Permit ppi'tcation <br /> Daie Received .�� Qb` ,2�1 � Phone Contact for Permit ��� C�� �� <br /> 1 <br /> Uwners Name L-?��,��(/ 7/�� ' TI` Owner's Phone Number ��� � � �,�� <br /> �t�s A���ss �0 , �?C `�7�� f�1r�� � 33�?' <br /> Fee Simpie Titleholder Name � Tit4ehoider Phone Number C� � �� <br /> Fee Simple Titleholder Address <br /> ,Job Address ���lS GN t�f�L.S �I� 15�7'-{l, �`I U� ��t# [� <br /> Sub Division Parce## <br /> . , . . .-. <br /> o Bio-Hazard Waste Storage-ANNUAt � � �umigefion Tent <br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier 11 or RQ Faclliry)ANNUAL <br /> QCar�tralted 8um � Hood installatian <br /> QEmergency Generetor�30 kw � LPlNatural Gas-Install�tfon <br /> � Emergency Generator>3(I kw � lPlNaturai Gas-ANNUAL Saie <br /> � �ire Protection Maintenance-ANNUAL o Places of Assembly-ANNUAL <br /> Q�y smi � er <br /> 5prinkfer ❑ d O � Recreationai 8urn ,t/t <br /> / 6� � <br /> Fire A}arrn C1 ❑ O � Sparklers ��"� <br /> Hood Gleaning ❑ O �a � Sprinkler System Instailations �� <br /> Hood Suppresston � C7 C} Cl � Standpipes(Sprinkier Sys} <br /> QFire Aiarm Installation � Toroh RoofingRar Kerile <br /> � FPre Pumps j � Waste 7ire Storage ANNUAL <br /> Fire Works <br /> F�ammabie Appiicatian-ANNUAI � ��r�—���� �/altt3ti0(1 4�P{p�SCt <br /> Fuel Tanks <br /> � Q�'t$I': <br /> ;ontractor Company s' <br /> iignature � Registered Y j N Fee Curre�t Y 1 N <br /> Address License# <br /> :LECTRICIAN Company <br /> iignature Registered Y/N Fee Current Y/N <br /> Address License# <br /> 'LUMBER ComPany <br /> ;ignature Regisiered Y/N Fee Current Y/N <br /> Address Lieense# <br /> AECHANICAI Company <br /> :ignature RegPstered Y J N Fee Current Y/!V <br /> Address License# <br /> )THER Company <br /> �igna#ure i Registered Y/N Fee Current Y/N <br /> Address Licanse# <br /> lirections: <br /> Filt out app#icat�on completely. <br /> Owner&Contractor sign back of application,notarized(Or,copy of sig d aontraot with owner) <br /> If over$25Q0,a Notice af Commencement is rec}uired(Mechanical wo over 55000) <br /> Suppiy iwo{2}sets of drawings with appticable dacumentation <br /> Ailow 10-14 days for review after submittai date. Parce #-obtained from Praperty Tax Notioe(http:/lappraiser.pascogov.com) <br /> ! <br /> I <br />