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813-780-0020 Glty of LepnyrhlllS 1-Ire Fax-d1;5-18w-UU21 <br /> Permit Application <br /> Phone Contact for Permit _- <br /> Date Received <br /> Owner's Name �LJ A1�1 GL� C N C k D Ze (� (�S Owner's Phone Number <br /> Owners Address Z S l J%o eT Kr kC? (2 of Ph r P,C 33 S-4 Z <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address (,Z 27a �1-2W ZePk '-A;11 - jL_ Lot# <br /> Sub Division Parcel# <br /> Bio-Hazard Waste Storage-ANNUAL Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct Hazardous Material(Tier li or RQ Facility)ANNUAL <br /> 0 Controlled Burn Hood Installation <br /> 0 Emergency Generator<30 kw LP/Natural Gas-Installation <br /> Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale <br /> El Fire Protection Maintenance-ANNUAL © Places of Assembly-ANNUAL <br /> try emi � ter <br /> Sprinkler El ❑ ❑ ❑ Recreational Bum <br /> Y Fire Alarm ❑ ❑ ❑ F_� Sparklers <br /> Hood Cleaning El ❑ ❑ ❑ Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ ❑ Standpipes(Sprinkler Sys) <br /> Fire Alarm Installation Torch Roofing/Tar Kettle <br /> Fire Pumps Waste Tire Storage ANNUAL <br /> Flammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> 0 Other: <br /> Contractor Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER Company , <br /> Signature Registered Y/N Fee Current Y/N <br /> _ Address License# <br /> Directions: <br /> a <br /> Fill out application completely. <br /> Owner&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#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />