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<br />06/13/2008 14:53 FAX <br />813-780-0020 <br /> <br />Date RB~h'ed <br /> <br />OWner's Name <br /> <br />Owner's Address <br /> <br />vfry QT,Lepnyrnrns rlre <br />Permit Application <br /> <br />r-Wi~~~'DU-UU~" <br /> <br />I <br />, , <br />I <br /> <br />'f' <br /> <br />P(:Inn.. r.n"b;r:t inr Ppnnli <br /> <br />" ~J.. r JJ~,.;l ~~Jd.~ '/11. <br />I 1'/. /} .. <br /> <br />Owner's Phone Number <br /> <br />Ie <br /> <br />I TItleholder Phone Number I <br /> <br />II <br /> <br />I <br />J <br /> <br />Fee Simple Titleholder Name <br />Fee Simple T1Ueholder Address <br /> <br />Job Address <br /> <br />sub Division <br /> <br />7~"":; Gca.i\ ~'"d. ~p~,("ill~, F ~ ..355"11 I Lot# C <br />I Parcel # I '.. <br />{UtlI J\U'IC:U rKUIVI t"KUt"t:KI T !"'^ NUlIvt:} <br /> <br />I"ullliy..IiUII T <:II It <br /> <br />-"-EJ <br />o <br />D <br />o <br />D <br />.0 <br /> <br />o <br />D <br />o <br />D <br />D <br />D <br /> <br />&Io-nazaro VvilSftl SllJrclge - A1I1Ntflo\L <br /> <br />B <br />o <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />o <br />D <br />o <br />. I <br /> <br />" Valuation of Project <br /> <br />Comm Exhaust Kitchen Hood/Ducl <br />Controll8d Bum <br />, , Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protectipn Maintenance - ANNUAL <br /> <br />Hazan:tous Material (Tier II or RQ Facility) ANNUAL _ <br />Hood Installation <br />LP/Natural Gas-lnstallation <br />LPlNatural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br />Recreational Bum. <br /> <br />~ _....wl'\ <br />o <br /> <br />Sprinkler <br />Fire Alarm <br />Hood C1ean/Suppression <br />Fire Alarm Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL ' <br /> <br />Sparlders <br />Sprinkler System Installations <br />StandpipeS (Sprinkler Sys) <br />Torch Roofing <br />Waste Tire Storage ANNUAL <br /> <br />. Fuel Tanks <br />Other: <br /> <br /> <br />. ec:mpany I <br />' Registered <br />License # I <br />~mpany I <br />Registered <br />License # I <br />Company 1 <br />Registered <br />License # '1 <br />Company ./ <br />Registered <br />License # I <br />Company I <br />Registered <br />License # I <br /> <br />/~~~r~c!;:nr;~N I <br />I <br />, <br />I' <br />I <br />I <br />I <br />I <br /> <br />. , <br /> <br />F~ Current' I <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y/N l <br /> <br />Y/N <br /> <br />Fee CUrrent <br /> <br />Y/N I <br /> <br />Fee CumlOt <br /> <br />Y/N <br /> <br />Y/N I <br /> <br />Fee Current <br /> <br />I Y/N I <br />I <br /> <br />All out application completely. <br />,'..- -- .--..',..-- -"ownl!l"lli'~SigffDaCkDfapj5JfC8IiOll. 'notanzea'{Of, copyOfSignecr"coi'itniCf'wiUHlWiief} <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 1 ~ 14 days for review after submittal date. <br />