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<br />oa/13/2if08 14:50 FAX <br />813:-780-0020 <br /> <br />Date R8~~8d <br /> <br />OWners Name <br /> <br />OWner's Address <br /> <br />Id1 002 <br />r-ax-tll;)- fHU-UU21 <br /> <br />:'f' <br /> <br />Glty ot.Lepnyrnllls t-Ire <br />Permit Application <br /> <br />Phnnl;l ('-""tad fnr Permit 'j ?;1.3 <br /> <br />Owner's Phone Number I <br /> <br />~~~.WlJ91~ <br />I] , ' I J' ". <br /> <br />~ <br />., <br />I <br /> <br />I <br />I <br /> <br />Ie <br /> <br />Fee Simple Titleholder Name <br />Fee .Simple T1tfeholder Address <br /> <br />.1 Titleholder Phone Number I <br /> <br />II <br /> <br />Job Address <br /> <br />3.3~Lf' <br /> <br />Sub Oiviskm <br /> <br />7050 <br /> <br />(7" " <br /> <br />BI.Jd. <br /> <br />FL. <br />'/ <br /> <br />I Lot# <br /> <br />c <br /> <br />7.eph1' J,i JJ~ , <br />I Parcel # <br /> <br />Elro-Mazard VVa&t8 Storage - A'NNtlAl. <br /> <br />Comm Exhaust KItchen HoodIDucl <br />Controll9d Bum <br />, Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />Sprinkler ~ <br />Fire Alarm 0 <br />Hood CleanlSuppression 0 <br />Are Alarm Installation <br />Fire Pumps <br />Fire Works <br />, Flammable Application- ANIliUAL <br />Fuel Tanks <br />Other: <br /> <br />OTHER <br />Signature <br /> <br />Address , <br /> <br />Directions: <br /> <br />lUtlll-\II'It:U t't(UM t'l"(ut""t:f'{ I T I,IV\. I~U 11\"t:.) <br /> <br /> <br />Contnictor' <br />Signature . . . ' <br />Address I LflCJ( ~~ FT--rff'~ ~., pI..' ,"". <br /> <br />I <br />'I <br />" <br />I <br />, <br />, <br />I <br />I <br /> <br />~ <br />o <br />D <br />o <br />D <br />D <br /> <br />. ,". . <br /> <br />o <br />o <br />,0 <br />o <br />D <br />D <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />. Address I <br /> <br />I <br /> <br />PLUMBER <br />Signature . <br />Add~S I <br />" MECHAN/1 <br />Signature ' <br />Address I <br /> <br />I <br /> <br />E:3' fiulllj!:/d~" T"...t <br />o Hazardous Material (Tier II or RQ Facility) ANNUAL <br />D Hood Installation <br />D lP/Natural Gas-Installation <br />D LPlNatuTal Gas-ANNUAL Sale <br />o Places of Assembly-ANNUAL <br />o Recreational Bum , <br />o ~parklers <br />D <br />D <br />D <br />D <br />t. <br /> <br />Sprinkler System Installations <br />StandpipeS (Sprinkler Sys) <br />Torch Roofing <br />Waste Trre Storage ANNUAL <br /> <br />, f Valuation of Project <br /> <br />..Company I <br />. Registered <br /> <br />Ucense # 1 <br /> <br />~pany I <br />Registered . <br /> <br />License # I <br /> <br />~:~./ <br /> <br />Ucense # 'I <br /> <br />~;::~ I <br /> <br />Ucense # I <br /> <br />Company I <br />Registered . <br /> <br />Ucense # I <br /> <br />Qun.Ok;, Gt-.n~'Jl <br />Y I N, r ~ee Current IY I N I <br />I <br /> <br />, <br />I <br /> <br />I <br />I <br /> <br />, <br />I <br /> <br />'. " <br /> <br />~CUrrent. I Y IN <br /> <br />Y/N <br /> <br />Y/N I <br /> <br />Y/N <br /> <br />Fee CUrrent <br /> <br />Y/N r <br /> <br />Fee CUlTent <br /> <br />Y/N <br /> <br />Y/N I Fee Current I Y/N I <br />I <br /> <br />All out application almplete/y. <br />" ,- -- . --" -...--. "'Olilir1i!!F&'Ql'mniCti"'!fgi'nmac(jf'appticatffifi, 'notarizei'l'{or,-copyofSigfiein:oi'itiliCfWflll CiiAiiiel'J <br />If over $2500, B Notice of Commencement Is required (Mechanical work over $5000) <br />, Supply two (2) sets of drawings wtIh applicable documentation <br />Allow 10-14 days for review after submittal date. <br />