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<br /> <br />Company ~ <br />Registered N Fee Current I <br />License # ~.11 ~.5P5 "on J JQ9'? I <br />Company I <br />Registered Y/N I Fee Current I Y/N I <br />License # , , <br />Company I <br />Registered Y/N I Fee Current I Y/N I <br />License # I I <br />Company I <br />Registered Y/N I Fee Current I Y/N I <br />License # I I <br />Company I <br />Registered Y IN " Fee Current Y/N , <br />License # I <br /> - <br /> <br />tfi0CLJ <br /> <br />813-780-0020 <br /> <br />Fax-813-780-0021 <br /> <br />Date Received <br /> <br />Pho~; Co~tact for Permit <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple TItleholder Name <br />Fee Simple 'TItleholder Address I <br /> <br />I ?'.w9&~:8~VIJ. ZiPhJg-::~7 rio! "33671'/ I Lot. <br /> <br /> <br />o Fumigation Tent <br />o Hazardous Material (Tier II or RQ Facility) ANNUAL <br />o Hood Installation <br />o <br />o <br />o <br /> <br />o Recreational Bum <br />o Sparklers <br />o Sprinkler System Installations <br />o Standpipes (Sprinkler Sys) <br />o Torch RoofinglTar KeWe <br />o Waste Tire Storage ANNUAL <br /> <br />t <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />D Bia-Hazard Waste Storage - ANNUAL <br />D Comm Exhaust Kitchen HoodlDuct <br />D Controlled Bum <br />D Emergency Generator < 30 kw <br />~ Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />, ~~~~ <br />Sprinkler 0 0 0 0 L--.J <br />Fire Alarm 0 0 0 0 C:J <br /> <br />~~ ~ ~R <br /> <br />LPlNatural Gas-Installation <br />LPlNatural Gas-ANNUAL Sale <br /> <br />Places of Assembly-ANNUAL <br /> <br /> <br />Fire Alarm Installation <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />Valuation of Project <br /> <br />Fuel Tanks <br /> <br /> <br /> <br />Contractor <br />Signature <br /> <br />Address <br /> <br />PLUMBER <br />Signature <br /> <br />Address r <br /> <br />MECHANICALI <br />Signature , <br /> <br />Address l <br /> <br />OTHER <br />Signature <br /> <br />Address [ <br /> <br />Directions: <br /> <br />/'1 <br /> <br /> <br />I <br /> <br />Iif.;, <br /> <br />I <br />I <br /> <br />B', <br /> <br />Fill out application completely. <br />Owner & Contractor sign back of app/icetion, 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 />