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813-7tiU-UU"LU � Lity ot�epnyr ins rire rax-u�a-�au-uun <br /> Permit Appl cation <br /> ate Received Phone Contact for Permit <br /> C✓n`„�.'a3'ii?SUn`%��.Sa►",.•��._ _ t�w..wra•cr.+��2'.Airi:����_S�_Y�.�-a•Hx�a..In—'trA'.n``-�._ . ...,L.�XS' f4'S"�`ss�r�=�'ni$F: _- _ �_�� <br /> / <br /> �wner's Name '� L.LIfJNCrE /Qc,.� ^�f7� G Owner's Phone Number � � � <br /> �wner's Address '� (p� ��T �//JG <br /> ee Simple Titleholder Name Titleholder Phone Number � � � <br /> ee Simple Titleholder Address <br /> ,�.��,.�_ �_:,�._�� <br /> ��=���^ ,�..�-;. - � > ..:a.� <br /> �b Address Lot# � <br /> ub Division Parcel# <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent �g � � <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier ii or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw a LPMatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> � emi � er <br /> Sprinkler � ❑ ❑ � � � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparlclers <br /> Hood Cleaning � ❑ ❑ ❑ � � SprinklerSystem Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) % �f� �� <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle �/ <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � � <br /> � Fire Works <br /> � FlammableApplication-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> :ontractor Company <br /> ignature � �( ' Registered Y/N Fee Current Y/N <br /> Address License# <br /> LECTRICIAN Company <br /> .ignature 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 /> �ECHANICAL Company <br /> �ignature 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 /> �ai:,.`u-:.�'s�`.�3r:�ar—i'.2;w^;f. .'w.�a,rs:�a.w-..,..�..:.s.a�rr.c,�a;xs-,�.��a�'-,.o-a::-�nea;xws�•a�w�tt.:�ai_..:'a._�i`w-`.�?:�5�=�.°'n':,4'a,73m.Y'�.=�r.§.,.s, s � ""�'��`a':=d.'.�.°"Jr2:,.c�4.',.i..� <br /> )irections: <br /> Fill out application completely. <br /> Owner&Gontractor sign back of application,notarized(Or,copy of signed ontract with owner) <br /> If over$2500,a Notice of Commencement is required(Mechanical work o r$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(httpJ/appraiser.pascogov.com) <br /> /o/3m�ao/ y� <br />