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813 - 780 -0020 ...., .-. _.... S Fite. Fax- 813 - 780-0021 <br /> Pemmit Application <br /> i <br /> _ - Phone Goltacffor Permit <br /> Oats mad �Li�� " �1 „_. <br /> Owners Name I Qr ivs. ll S Cin( e414Z. -• o 1 Owner's Phone Number 1 D 1 '2?7 117 f d 1 l a 0 <br /> Owners Address 4 I ‘ 4 1 t t i f G € . I . 1 81 r • Z e - e L r V W i l t s h r L 3 Ss' <br /> Fee Simple Titleholder Name 1 I Titleholder Phone Number I I I I I <br /> Fee SimpleTitleholder Address I <br /> slob Address 16) q 4 6 Ga. l( g 1 Joi . Z epk r 4 it, It 5 I FL 3 8 5 ci Lot # <br /> Sub Division 1 I Parcel # 1 <br /> D Bfo- Hazard Waste Storage - ANNUAL Q Fumigation Tent <br /> El Comm Co Exhaust Kitchen Hood/Duct ri Hazardous Material (Tier II or RD Factllty) ANNUAL <br /> D Controlled Bum . D Hood Instatlatlon <br /> D Emergency Generator < 30 k LPndarsal Gum -installation on <br /> D <br /> D Emergency Generator 30 kw D LPnisa.al Gas - ANNUAL Sate / —9 <br /> 0 9 <br /> Rue Protection Maintenance - ANNUAL D - Places of Assembly-ANNUAL <br /> SprWder ❑ ❑ Recreational Bum <br /> Are Ahann D 0 ❑ 1 1 D S - / 9h ✓ ° <br /> Hood Cleaning D❑ ❑ ❑ I 1 D Sp System ketallations <br /> Hood Suppression D ❑ ❑ ❑ ( I n S andpipes (Sprinkler Sys) ' N <br /> D Fire Alarm Installation D Torch Roofing/Ter Kettle <br /> H e Pumps Waste The Storage ANNUAL <br /> Fine Works <br /> Raminable Application- ANNUAL -I Valuation of Project <br /> Fuel Tanks <br /> IIII Other: <br /> Contractor CornpanY E WIT ..� it ��i i ice J <br /> _ AS S• <br /> Signature L t/ l , • Registered Y / N Fee Current Y / N <br /> Add IAp, • _ a. _ . 4.0, -. - a license# I 1 4 6 Is a-7 u aoe) =0071 _ <br /> ELECTRIC r• Company <br /> Signature ( Registered I Y/ N . J Fee Current I Y/ N I <br /> Address I I License* I I <br /> PLUMBER Company <br /> Signature Registered I Y/ N I Fee Current I YIN 1 <br /> Address I I License* I I <br /> MECHANICALI Company <br /> Signature Registered I Y/ N J Fee Current J Y/ N I <br /> Address I i - License# I - I <br /> OTHER , ,, A G -. Company ETA I mot, CW ! , A1 ve <br /> J i. Registered Y / N Fee Current Y / N <br /> . _..- t Ir f•Ar• PMSECTIZ,,, . 7 /! • License # P. $ : , . . it • r . <br /> ' ir cv lO a. <br /> ... - r..: :i*SY.i ^. ........._ ..a'c4'..- ..Yi'x.'Y�'..... -.. ,_.;...':".'_. -NRl , -- 5., Las+J18L/' ...w.�s es c,.... : - F^�PF'. - ✓. s.c... �..+. .. t - .._T p.rii- .ia'vC.a <br /> Dir@eCt .._._ <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over S2500, a Notice of Commencement is re work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review alter submittal data. Parcel # - obtained from Property Tax Notice (Mipliappra pascogov.eom) <br />