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<br />813-780-0020
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<br />Permit ii.p;Jiication
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<br />Date Received \ ~I'" Phone Contact for Permit I
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<br />Owner's NamE:
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<br />Owner's Address
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<br />Fee Simple Titleholder Name
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<br />Fee Simple Titleholder Address
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<br />Job .ll.ddress
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<br />Sub Division
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<br />BID-Hazard Waste Storage - ANNUAL
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<br />Contractor
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<br />ELECTRICI.t>,N
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<br />.Address 1
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<br />PLUMBER
<br />Signature
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<br />Address I
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<br />MECHANICAL I'
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<br />Address i
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<br />OTHER
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<br />Address
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<br />Comm Exhaust Kitchen Hood/Duct
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<br />Controlled Bum
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<br />Emergency Generator < 30 ,,1,'
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<br />Emergency Generator;:> 30 1,,'1
<br />Fire Protection Maintenance.. ANNUAL
<br />Sprinkler I I
<br />Fire Alarm 0
<br />Hood Clean/Suppression ~
<br />Fire Alarm Installation
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<br />Fire Pumps
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<br />Fire Works
<br />FLammable Applicau;:m- ANNUAL
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<br />Fuel Tanks
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<br />Parcel #:
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<br />Fum;g3tjcn Ten~
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<br />! Lot#
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<br />Hooe! Installation
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<br />Hazardcus Material (Tier II or RQ Facility) ANNUAL
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<br />Ccmpany
<br />Registered
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<br />License #
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<br />Company I
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<br />Li<,-ense #
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<br />Company
<br />Registered
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<br />License #
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<br />Company
<br />Registered
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<br />License '#
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<br />Company
<br />Registered
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<br />LP/Natur;;;j Gaf~;nstallaticn
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<br />LP/Naturol Gas-ANNUAL Sale
<br />Places of Assembly-ANNUAL
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<br />Sparklers
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<br />Sprinkler System lnstallations
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<br />Stanupipes (Sprini-:.1ef Sys)
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<br />'Torch RO.Jfing
<br />Waste TIre Storage ANNUAL
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<br />'\ Valuation of Project
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<br />Other:
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<br />R€o:::reaticnal BL:m
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<br />Y/N
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<br />Y/N
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<br />Fee Current
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<br />Y/N
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<br />~.~~~"~J ,~, i License #
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<br />Fill our application completely.
<br />~~er & Contractor.:~gn back oT application, r.ota:lzed (O~, copy of signBG contra::t with O\vner)
<br />.r Oil er $2500. a Noti...", of Commencemen: IS req:.ll,ed {Mechanicai WaIt, ,er $5000':
<br />S~pply two (2) sets of drawings with applicable {Jocumentaiion .
<br />!',,;,:w '1 [l..14 cays fo, review after submittal date.
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<br />Fee Current
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<br />Fee Current
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<br />Fee Current
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