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<br />, -813-780-0020 . " J <br /> <br /> <br />~~~:z~~;:~:~,_"~,_L<~,,~.l:,,,::-.tl"._- ~ <br />l ~)>..(vr;-/? a,q/< (];dL p- <br />i 30 t'l/ (? k (.) i3 )-/({J(J.5r;- <br />I <br />I <br /> <br />)wner's Name <br /> <br />)wner's Address <br /> <br />~ <br /> <br />:ee Simple Titleholder Name <br />:ee Simple Titleholder Address <br /> <br />I:::~,a~-r~-~~m"_b~ <br />I <br /> <br />>::~<:{:~~~~.._~~Y~~1. <br /> <br />;ub Division <br /> <br />Contractor <br />Signature <br /> <br />Address I <br /> <br />ELECTRIClA1 <br />Signature <br /> <br />Address I <br /> <br />PLUMBER I <br />Signature <br /> <br />Address I <br /> <br />MECHANICALI <br />Signature <br /> <br />Address I <br /> <br />~~ <br /> <br />Fax-813-780-0021 <br /> <br />Owner's Phone Number <br /> <br />] <br /> <br />I TItleholder Phone Number I <br /> <br />II <br /> <br />II <br /> <br />Parcel # <br /> <br />I <br /> <br />'-~~~'<<*M!t~H~~:;;:~:",;t;:~?H.:u.t:!W"~lif~ <br /> <br />.. <br /> <br />I~ .. <br /> <br />1,",,~~J:lif'1 <br /> <br />~'9)'if <br /> <br />D <br />D <br />D <br />D <br />D <br />D <br /> <br />Bic-Hazard Waste Storege - ANNUAL <br /> <br />Comm Exhaust Kitchen HoodIDuct <br /> <br />Controlled Bum <br /> <br />Emergency Generator < 30 kw <br /> <br />Emergency Generator> 30 kw <br />Are Protection Maintenance - ANNUAL <br /> <br />'O[9!!!l ~ ~ ~ <br />Sprinkler 0 0 0 L-J <br />Fire Alarm 0 0 0 0 c=J <br />Hood Cleaning 0 0 0 0 c=J <br />Hood Suppression I2l 0 ~ 0 c=J <br /> <br />~ ~~,=-'- <br /> <br />D Other: I <br /> <br />:~z~~~=~,;;.~~ <br /> <br />I <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br /> <br />D <br />D <br />D <br />D <br />D <br />o <br />D <br />D <br />D <br />D <br />o <br />o <br />~ <br /> <br />Fumigation Tent <br />Hazardous Material (T1ef' II or RQ Facility) ANNUAL <br /> <br />Hood InstaUation <br /> <br />LPINaturaI Gas-Installation <br />LPINatural Gas-ANNUAL Sale <br />Places of Assembly-ANNUAL <br /> <br />;:: j.yr' <br /> <br /> <br />Recreational Bum <br />Spartders <br />Sprinkler System Install <br />Standpipes (Sprinkler Sys) <br />T arch RoofIngfTar Kettle <br />waste Tire Storage ANNUAL <br /> <br /> <br />Jf 9"/:) ~ <br /> <br />"'j .;-2- <br />vi. :2 6 <br /> <br />Valuation of Project <br /> <br />.L..'~ ~_ =P~x.;.~-~~~l".i <br /> <br />.... llilrl. <br /> Company <br /> Registered <br /> License # <br /> Company <br /> Registered <br /> License # <br /> Company <br /> Registered <br /> License # <br /> Company <br /> Registered <br /> License # <br /> Company <br /> Registered <br /> License # <br /> <br />OTHER <br />Signature <br /> <br />Address <br /> <br />birections: <br /> <br /> <br />I Y I N Fee Current .1 <br />I <br /> <br />I Y / N I Fee Current I <br />I <br /> <br />I Y I N I Fee Current I <br />I <br /> <br />I Y / N I Fee Current I <br />I <br />~J/h~ F7:,,, <br />CJ.!![] Fee Current 1 <br /><1 <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Y/N <br /> <br /> <br />All 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 $50(0) <br />Supply two (2) sets of drawings with appNcable documentation <br />Allow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />