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813- 7800020 Fi ' dill Fax -813- 780-0021 i <br /> ��/ 111 <br /> Date Received - Phone Contact for Pehmit <br /> owners Name 1 -'Lots 1 Owners Plane Number NM 1 0 1 I 1 - <br /> owners Address 11 L , Clam (3 \ P 7.4pV2w,kks, I <br /> Fee Simple Titleholder Name 1 I Titleholder Phone Number 1 1 1 1 1 I <br /> Fee Simple - ntletalder Address 1 I <br /> Job Address <br /> Sub Division I 1 Parcel # <br /> F Bio -Hazard Was Storage - ANNUAL n Fumigation Tent <br /> 0 Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier 11 or RQ Fatality) ANNUAL <br /> ED Controlled Burn n Hood Installation <br /> 0 Emergency Generator < 30 kw n LP/Natural Gas - Installation <br /> Q Emergency Generator> 30 kw n LP!Nahral Gas - ANNUAL Sale <br /> CI Are Protection Maintenance - ANNUAL in Places of Assembly- ANNUAL <br /> {i <br /> SKxinider n ❑ ❑ 0 n Recreational Bum <br /> Fire Alarm t ❑ ❑ ❑ ❑ 1 1 0 Sparaers <br /> Hood Cleaning ❑ ❑ ❑ I I 0 y Spr Sy r Knstailations <br /> Hood Suppression ❑ ❑ ❑ 1 1 1-1 1 Standpipes (Sprinkler Sys) <br /> ED Fire Alarm Installation a Torch Roofing/Tar Kettle <br /> M. Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works ' <br /> Fie APPS- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> seer. <br /> Contractor l� w YIN j Feu Current , YIN Signature �I - ..►0 -_ 1� <br /> ! License erse # 1 I <br /> Address ���. r�� _ ti �— <br /> ELECTRICIAN 1 <br /> Signature Registered _ Y / N 1 Fee Current [ YIN 1 <br /> Address 1 1 License # I <br /> PLUMBER I I <br /> Signature Registered Y/ N I Fee Current ' Y/ N 1 <br /> Address I I License # 1 1 <br /> MECHANICAL Company <br /> Signature <br /> Registered Y/ N I Fee Current I Y/ N <br /> Address 1 I License # ( <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I j License # 1 ( ti <br /> Directions: <br /> FM 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.(Mechical work over $5000) <br /> Supply two (2) sets of drawings with applicable documerdation <br /> Allow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (htlpl /appraiser.pascogov.com) <br />