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813-760-0020 <br /> Permit Application cy <br /> Date Received Phone Contact for Permit / ��S / O S <br /> Owner's Name j L( k`j r/'A(0— t � Owner's Phone Number <br /> Cwnees Address ,J;/ � f, 7— '1 t ¢� , l Y L.. 3 3$ t- <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address' `t�i1 rs� S Lot# . <br /> Sub Division Parcel# IJ-o2cC� 02 1 't70/(� --G`sgs&'0-6- 00 <br /> a Bio-Hazard Waste Storage-ANNUAL o Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct Hazardous Material(Tier II or RC±Facility)ANNUAL <br /> ��(( <br /> Controlled Burn Hood Installation <br /> ❑ Emergency Generator<30 kw F-1 LPINatural Gas-Installatior <br /> Emergency Generator}30 kw � LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL . { <br /> [t:1tr Semi rA—n1J Othor <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ Sparklers , VV <br /> Hood Cleaning ❑ ❑ ❑- ❑ ❑ Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ ❑ ❑ Standpipes(Sprinkler Sys) p <br /> Fire Alarm Installation Torch Roofing/Tar Kettle 6L+} <br /> ❑ Fire Pumps Waste Tire Stomoe ANNUAL <br /> Flammable Application-ANNUAL /$�G�_� Valuation of Project <br /> Fuel Tanks <br /> ❑ Other: �-�- -- - J <br /> Contractor <br /> Company �I/-7(� �►f S �� - <br /> Signature ,1 r n Lip * <br /> Registered /N Fee Current Y/ <br /> Address. r, L'o t t vv\ �ct tin 3 3 0 License# F�6 G1 Cj U $Sri <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y l'N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current I_Y/N_� <br /> Address <br /> P y ,.. '---� <br /> OTHER Co man M' G' <br /> Signature Registered Y/ Fe � <br /> Address License# ��j-o2Ci C3 Lt Ci ${o!v <br /> Directions: _. <br /> Fill out application completely. <br /> Owgar&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 4-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />