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<br />City Ot.Lepnyrnms t-Ire <br />Permit Application <br /> <br />PhnnA r.nnl>o~ fnr PAqJllt ~j~13 <br /> <br />Owner's Phone Number I <br /> <br />Id1 003 <br />r-a;(-tll;1-/lSU-UUll <br /> <br />06/13/2008 14:51 FAX <br />813-780-0020 <br /> <br />gate R.G:lli'.~ <br /> <br />OWner's Name <br /> <br />OWner's Address <br /> <br />~~~,WfJ'Il. <br />1'1 I J <br /> <br />~~ <br />I <br />I <br /> <br />'f' <br /> <br />Ie <br /> <br />II <br /> <br />I <br />J <br />liP 7 1..9 <br />I <br /> <br />I TItleholder Phone Number <br /> <br />,Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />(;,qJl81I1d. <br /> <br />'2tfh~,J.i/~F/'. ' .~3s'1l I Lot# C <br /> <br />I Parcel # I' , <br />lUlj II\UvJ:;U r-KUM t'KUt't:K I T I,IVI. NU 11"'t:) <br /> <br />FUllljy..li~ IT.., It <br /> <br />-LJ <br />o <br />o <br />.D <br />o <br />,0 <br /> <br />D <br />D <br />,0 <br />o <br />o <br />o <br /> <br />&lo-r1azard VVaStB SowrclQe - ANNUA1. <br /> <br />Coinm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br />. Emergency Generator < 30 Jew <br />Emergency Generator > 30 kvv <br />Rre Protection Maintenance - ANNUAl. <br /> <br />Hazardous Material (Tier II or RQ Facility) ANNUAl. <br />Hood Installation <br />LP/Natural Gas-lnstaRation <br />LPlNatural Gas-ANNUAL Sale <br />Places of Assembl~-ANNUAl. <br />Recreational Bum . <br />Sparklers <br />Sprinkler Syst<<n Ins~latlons <br />Standpipes (Sprinkler Sys) <br />Torch Roofing <br />Waste Tire Storage ANNUAL <br /> <br />~ a",,"h.cl~ <br />o <br />o <br /> <br />Sprinkler <br />Fire A1ann <br />Hood CleanlSuppression <br />Fire A1ann Installation <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL . <br /> <br />FUel Tanks <br />Other: <br /> <br />'I Valuation of Project <br /> <br /> <br />Contractor . .. Cl?mpany I ~j(T"~k, bTlnE:' If . <br />Signature ' Registered Y IN, . '. ~ee CUrrent-Y IN. I <br />Address I Lflt:)( (!)ti.~Fcwr ,~. ~ ~. .,,,,,,q Ucense # I I <br />ELECTRICIAN I Company I '. , . <br />Signature I Registered Y/N Fee Current . Y/N I <br />Address I 'I Ucense# I I <br />PLUMBER I I Company ., <br />Signature . Registered Y/N Fee Current Y/N I <br />Address I I Uoense # I I <br />: MECHANIC4 I Company I <br />Signature . Registered Y/N. r Fee Current Y/N I <br />Address I I Ucense # , I <br />OTHER I I Company I <br />Signature Registered Y/N I Fee Current Y/N I <br />Address t I Ucense # I l <br />Directions: <br /> <br />Fill out application completely. <br />" ..- -- ..- --","'''- -'o-WfteJ"it'connctOnlgff611acorappnaition;'i'iofiinziir{~copyof'srgnecrcomraaWftlfCiWi'1el'J <br />If over $2500, a Notice of Commencement Is required (Mechanical work over $5000) <br />. Supply twc (2) sets of drawings with appDcable documentation <br />Allow 10-14 days for review after submittal date. <br />