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I <br /> 813-780-ou2o Uliy OT Gepnyrniiis r-Ire r-ax-a,s-iiw-uut, <br /> ' • . Permit Application <br /> Date Received Q Phone Contact for Permit <br /> Owner's Name /'a 8r ZFP11A ywil w Owner's Phone Numbler O <br /> Owner's Address 5 5 Cj 6 1 �T <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address �Z f�l /J�V C.P't�+� +1� [�j PL. _ Lot# <br /> Sub Division Parcel# <br /> Bio-Hazard Waste Storage-ANNUAL Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct Hazardous Material(Tier 11 or RQ Facility)ANNUAL <br /> �j Controlled Burn• Hood Installation <br /> Emergency Generator<30 kw, LP/Natural Gas-Installiatio <br /> Emergency Generator>30 kw LP/Natural Gas-ANNUAL ale <br /> Fire Protection Maintenance-ANNUAL Places of Assembly-ANN AL <br /> try emi ®n ter <br /> Sprinkler ❑ ❑ ❑ Recreational Burn <br /> Fire Alarm ❑ ❑ ❑ Sparklers `7,0 <br /> Hood Cleaning ❑ ❑ ❑ Sprinkler System Installati ns <br /> Hood Suppression El ❑ ❑ ❑ Standpipes(Sprinkler Sys): <br /> Fire Alarm Installation Torch Roofing/Tar Kettle <br /> Fire Pumps Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application-ANNUAL 7ool Valuation of Project <br /> Fuel Tanks <br /> I <br /> Other: <br /> .71 <br /> Contractor Company <br /> Signature Registered N 1 Fee Current /N <br /> i <br /> Addre License (ObV I Zp <br /> ELECTRICIAN ' Company <br /> Signature Registered Y/N Fee Current <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 I Fee Current Y/N <br /> Address License# <br /> Directions: _ <br /> Fill out application completely. <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) f <br /> i <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(ht p://appraiser.pascogov.com) <br /> i <br />