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<br />Permit Application
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<br />. jC) $'6 f?rJL'- 6LtJ D :
<br />'ee Simple Titleholder Name I I TItleh0Ider Phone Number I II II
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<br />I I Lot # I
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<br />D Fire Alarm Installation
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<br />~ Fire P\.mps
<br />RreWorIcs
<br />. Flammable ApplicatiOn- ANNUAL
<br />Fuel Tanks
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<br />~:=r I = Y; N I Fee Cunern I ~:;--_._=--
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<br />Address I Ucense # I
<br />~CTRICIANj Company
<br />,lQnature I Reglsteted Y I N I Fee CUrrent I Y I N I
<br />Address I license # I
<br />'lUMBER I Company
<br />iignature Registered Y I N I Fee Current I Y I N I
<br />Address I License # I
<br />~ECHANICALI Company
<br />'Ignature . Registered Y I N I Fee Current I Y I N I
<br />Address I LIcense # I
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<br />~:HER I /r' ~/A//.t--vL.. Company S~'<!'/ry" r;;<e C:o"',Oju:.,-"rr-
<br />>Ignature . . y L-. ":'/ ~ . Registered cY:'bN I Fee Current I Y I N _
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<br />Fill out application c:ornpIelBIy.
<br />Owner & Contractor: sign back of appIlcatlon. notarized (Or. copy of signed conlract with owner)
<br />If over $2500, a Notice of COmmellC:ei'l8Ilt is required (MechanIcal work over $50(0)
<br />Supply two (2) sets of drawings with applicable cfocumentation
<br />Allow 10-14 days for review after submitlal date. Parcel # - obIained from Property Tax Notice (http://appraiser.pascogov.com)
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<br />>wner's Name
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<br />>wner's Address
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<br />ob Address
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<br />Bio-Hazard Waste Storage - ANNUAL
<br />Comm Exhaust Kl1chen HoodIOuct
<br />C0ntr0lIed Bum
<br />Emergency Generator < 30 kw
<br />Emergency Genera1Dr> 30 kw
<br />Rre Protection Malrdenanc:e - ANNUAL
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<br />0" 0 ~O c=J
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<br />Sprinkler
<br />Fire Alarm
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<br />Hood CleanIng
<br />Hood Suppression
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<br />Ftm1lgaIIon Tent
<br />Hazardous MatIIlrIal (Tier II or RQ Facility) ANNUAL
<br />Hood InsIaIIation
<br />LPJNaturaI Gas-InstaI/aIiO
<br />LP/NaluraI Gas-ANNUAL Sale
<br />Places of AssembIy-ANNUAL
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<br />Recreational Bum
<br />Sparklers
<br />Sprinkler System Installations
<br />Standpipes (Sprinkler Sys)
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<br />Torch RoofingITar Kettle
<br />Waste Tire SlDrage ANNUAL
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<br />~ Valuation of Project
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