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<br />06/13/2008 14:52 FAX <br />813-780-0020 <br /> <br />Date RSl:si"vd <br /> <br />owners Name <br /> <br />Owner's Address <br /> <br />Lirty OT,Lepnymllls rlre <br />Pennit Application <br />Phnnp. r.(lp~rl fnr Pennlt .~ ~U~ ~~ t,.~ ~.c ,jd~ 9.fJ /, <br /> <br />Owner's Phone Number I . II., I J <br /> <br />~" <br /> <br />,-1';' <br /> <br />-- <br /> <br />./ <br />I <br /> <br />r~-g?~'OU-UULl <br /> <br />I TItleholder Phone Number <br /> <br />I <br />I <br />j7frJ43 <br />I <br /> <br />Fee Simple TiUeholder Name <br /> <br />Fee Simple TItleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />II <br /> <br />Ie <br /> <br />~Q. \\ '&\"d. <br /> <br />2tP"1,#till\ <br />,. Parcel # <br /> <br />, FL.' :s 3 St.41 I Lot# C <br />'I <br /> <br />\UD II\lNCLJ r-t\UM t't\ut't:t\ I Y \1\A NU 1Il-t:) <br /> <br />~ <br />o <br />D <br />o <br />D <br />o <br /> <br />o <br />D <br />,D <br />o <br />o <br />D <br /> <br />1::::1' "ullli!l..II~1I T..1I1 <br />D Hazardous Material (Tier II or RQ Facility) ANNUAL _ <br />o Hood Installation <br />o LP/Natural Gas-lnstallation <br />EmelgencyGenerator > 30 kw 0 LPlNatural Gas-ANNUAL Sale <br />Fire Protection'Maintenance - ANNUAL D Places of Assembly-ANNUAL <br />Sprinkler . ~ ~c.."- f 1-fA) 0 Recreational Bum. <br />o . 0 Spanders <br />Hood Clean/SuppreSsion D D Sprinkler, System lil~llations <br />D <br />D <br /> <br />o Waste Tire Storage ANNUAL <br /> <br /> <br />I <br /> <br />tllD-Mazard Waste Sttlrage - ANNttAL <br /> <br />Col1lm Exhaust Kitchen HOodlDuct <br /> <br />ControllSd Bum <br /> <br />. Emergency Generator < 30 kw <br /> <br />Fire Alarm <br /> <br />Fire Alarm Installation <br /> <br />Fire Pumps <br /> <br />Are Works <br /> <br />Flammable Application- ANNUAL <br /> <br />Fuel Tanks <br /> <br /> <br />Other: <br /> <br />Contractor <br />Signature, , . <br />Address I Lf7(;)( C)Ot.k.. Pr.rr_~- ~ p/-' ,""It <br /> <br />ELECTRICIAN <br />Signature I <br /> <br />, Address I <br /> <br />PLUMBER I <br />Signature ' <br />Address I <br /> <br />. MECHANI1 <br />Signature ' <br /> <br />Address I <br /> <br />OTHER I <br />Signature <br />Address , <br />Directions: <br /> <br />StandpipeS (Sprinkler Sys) <br />Torch Roofing <br /> <br />I <br /> <br />Valuation of Project <br /> <br />f <br />I <br />I <br />I <br /> <br />H Company I <br />. Registered <br />License # I <br />Company I <br />Registered <br />License # I <br />Company J <br />Registered <br />License # '1 <br />Company I <br />Registered <br />Ucense # I <br />Company I <br />Registered <br />License # I <br /> <br />6. ~Il"'" G-r. nfl:! Jf <br />Y IN, f ~eeCummt IYI N. I <br />I <br /> <br />I <br />,. <br /> <br />I <br />I <br /> <br />I <br />I <br /> <br />I <br />I <br /> <br />'. '" <br /> <br />Fee' Current' , <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee CUrrent <br /> <br />Y/N I <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N I <br /> <br />Fee Current I <br /> <br />Y/N <br /> <br />All out application completely. <br />.....OWfii!I"!<'COrl1nIemnlgJ'rbllt:K-Oflippncatfon. 'nofiftZijO'{Or-;-capy-ofSigm;cr"coiili1ierWftlf owiUir] <br />If over $2500. a NoUce 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. <br />