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o�r�ov-uvcu �uy oi�e nyrnms rire rax-tsia-itsu-vuz� <br /> ' Permit pplication <br /> Date Received (1�/�3/r�[ Phone Contact for Permit �3 s S ' 9 3 S <br /> Owner's Name �r7S 2 L� v�,V l Owner's Phone Number t� �3 � 3 S <br /> Owner's Address /•�,rJ�l� � /�p ?'���7}" � 3 3 6 7� <br /> Fee Simple Titiehoider Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> 'Job Address U�/—/�/V G> ��Z�� �4 G�4L�- �L Uf�, Lot# � <br /> Sub Division Parce�# <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � ControHed Bum Q Hood Installation <br /> � Emergency Generator<30 kw � LPlNatural Gas-installation <br /> aEmergency Generator>30 kw a lP/Natural Gas-ANNUAL Sale <br /> � Fi►e Protection Maintenance-ANNUAL a Places of Assembly-ANNUAL � <br /> �y emi �n er /1 <br /> i��' <br /> Sprinkler � ❑ � ❑ � Recreational Burn � <br /> Fire Alarm � ❑ ❑ ❑ � Sparklers �l` <br /> Hood Cleaning � ❑ � ❑ � Sprinkler System Installations <br /> Hood Suppression � � ❑ ❑ � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation Q Torch Roofing/Tar Kettle <br /> Q Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Worics <br /> � Flammable Application-ANNUAL r--, Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> .^,ontractor C//�y� �f�., / Company � G� <br /> iignature ��� Registered Y/N Fee Current Y/N <br /> Address License# <br /> =LECTRICIAN Company <br /> iignature Registered Y/N Fee Current Y/N <br /> Address License# <br /> 'LUMBER Company � <br /> �ignature Registered Y/N Fee Current Y/N <br /> Address License# <br /> dECHANICAI Company <br /> �ignature Registered Y/N Fee Cu►rent Y/N <br /> Address License# <br /> )THER Company <br /> ��gnature Registered Y/N Fee CuRent Y/N <br /> Address License# <br /> )irections: <br /> Fill out application completely <br /> Owner 8 Contractor sign back of application,notarized(Or,copy of sign d contract with owner) <br /> If over$2500,a Notice of Commencement is required(Mechanical work ver$5000) <br /> Supply two(2)sets of drewings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel -obtained from Property Tax Notice(httpJ/appraiser.pascogov.com) <br />