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<br />lwners Address So 7/ R
<br />:ee Simple Titleh0ider Name I TItleh0Ider Phone Number I II
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<br />I I Lot#
<br />I I Parcel # I
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<br />>wners Name
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<br />ob Address
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<br />jub Division
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<br />Address I
<br />:LECTRICIANj
<br />,ignature I
<br />Address I
<br />
<br />'LUMBER I
<br />,ignature .
<br />Address I
<br />
<br />~ECHANICALj
<br />'lgnaWre I
<br />
<br />Permit Application
<br />
<br />o
<br />D
<br />o
<br />o
<br />o
<br />D
<br />
<br />Bio-Hazard Waste Storage - ANNUAL
<br />Comm Exhaust Kitchen HocxlIDuct
<br />C0ntr0lIed Bum
<br />Emergency Generator < 30 kw
<br />Emergency Generator> 30 kw
<br />Fire Protection MaintIIlnance - ANNUAL
<br />'OIB!!!ll ~ ~ ~
<br />OOOL-J
<br />OOOOc=J
<br />Doooc=J
<br />~O av--O c=J
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<br />D FIl'8 Alarm Installation
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<br />B
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<br />D Fuel Tanks
<br />D Other: I
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<br />::Ontractor I
<br />
<br />;ignature
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<br />Sprinkler
<br />
<br />Fire Alarm
<br />
<br />Hood Cleaning
<br />Hood SuppressIon
<br />
<br />Fire Pumps
<br />FireWorks
<br />Flammable Application- ANNUAL
<br />
<br />II
<br />
<br />D
<br />o
<br />D
<br />o
<br />o
<br />D
<br />D
<br />D
<br />D
<br />o
<br />D
<br />o
<br />~
<br />
<br />Fumigation Tent
<br />Hazardous Material (T1EIl" II or RQ Facility) ANNUAL
<br />
<br />Hood hlAllatiol,
<br />
<br />LPJNatI.I'aI Gas-lnstallation
<br />LPINalI&'aI Gas-ANNUAL Sale
<br />Places of AssembIy-ANNUAL
<br />
<br />Recreational Bum
<br />Spartders
<br />Sprinkler System b Istallations
<br />Standpipes (SprinIder Sys)
<br />
<br />Torch RoofingITar Kettle
<br />Waste Tn Storage ANNUAL
<br />
<br />I Valuation of Project
<br />
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />
<br />Address I I LIcense # I I
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<br />~THER I /e ~~~-VL I Company I S~,a/""" r::<?E' COl.>'Of""'-A.rr-
<br />'Ignature . _ ..Y . v~ - .. Registered. cDN I Fee Cunent I Y I N _
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<br />
<br />Fill out application ampIeteIy.
<br />Owner & Contractor sign back of appIlcation, noIarized (Or. copy of signed contract With CMner)
<br />If over S25OO, a Notice of Commencement is requinId (MechanIcal work over $50(0)
<br />Supply two (2) sets of drawings With applicable documentation
<br />Allow 1~14days for review aflersubmittal date. Parcel #- oblained from Property Tax Notice (htIp:l/appralser.pascogov.com)
<br />
<br />Company
<br />Registered
<br />
<br />I Y/N I FeeCwrent I Y/N'
<br />I
<br />
<br />Ucense #
<br />
<br />Company
<br />Registered
<br />
<br />License #
<br />
<br />Y/N I FeeCUrrent I Y/N I
<br />I
<br />
<br />Company
<br />Registered
<br />
<br />Ucense #
<br />
<br />Y/N I FeeCwrent I Y/N I
<br />I
<br />
<br />Y/N I Fee Current I Y/N I
<br />
<br />Company
<br />Registered
<br />
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