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<br />813-78M02~ CI~ec;:,,~:~:~;:re \ 1 lq ~ F~.813-78o.<l021 <br />~=-_L' .______ d_.L.~.zo.Ji.,P~_~,:,,~n;~,bL,~ JJ.. ~I <br />I Llfs2LD H~~'Ljj I ~;'P"'dmbe' ~1.3 ~ IS-::; 1'135/!1 <br />PO.E(JX 1I/7~ ____MP,1 +-L 3'36'47 : = : <br /> <br />I I Titleholder Phone Number II II I <br /> <br />I I <br />'jt-I7T.::F C-M'SAR$ S538 GALL 13LVlJ I Co" I I <br /> <br />. I Parcel # I <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple Titleholder Address <br /> <br />Job Address <br /> <br />Sub Division <br /> <br />D Fire Alarm Installation <br /> <br />D <br />B <br /> <br />D Fuel Tanks <br />D Other: <br /> <br /> <br />~~~:~~::r ! 6;; <br /> <br />Address. _ <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />ELECTRICIANI <br />Signature <br /> <br />Address I <br /> <br />PLUMBER <br /> <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br /> <br />Signature <br /> <br />Address I <br /> <br />OTHER <br /> <br />Signature <br /> <br />Bio-Hazard Waste Storage - ANNUAL <br />Comm Exhaust Kitchen Hood/Duct <br />Controlled Bum <br />Emergency Generator < 30 kw <br /> <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br />~~~~ <br />Sprinkler D 0 0 0 L-J <br />Do ooc=J <br />~ [;l' 0 0 c=J <br />Do ooc=J <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />Fire Pumps <br /> <br />Fire Works <br /> <br />Flammable Application- ANNUAL <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Fumigation Tent <br />Hazardous Material (Tier II or RQ Facility) ANNUAL <br />Hood Installation <br />LP/Natural Gas-Installation <br />LP/Natural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br /> <br />Recreational Bum <br /> <br />Sparklers <br />Sprinkler System Installations <br />Standpipes (Sprinkler Sys) <br />Torch Roofingrrar Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Valuation of Project <br /> <br />~-lrtMW:t FL <br /> <br />3:16-11 <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Ui.//fP1<.S-F <br />Y / N Fee Current <br /> <br />f~fNV(c;ES <br /> <br />I <br /> <br />Y / N I <br />I <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br /> <br />Registered <br /> <br />License # <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fill out application completely, <br />Owner & Contractor sign back of application. 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 />