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City Of� F� stt I I �3 Fax -813- 780 -0021 _ _._ <br /> 81 4-780-0020 Appl icaUOfl <br /> Date Received <br /> Phone Contact for Permit <br /> -- -� � 1 .- ►�o I f�� I <br /> `` Owns Phone Number owners Name <br /> owners Address C.2 a.V. \ Titleholder Phi N I I 1 I <br /> Fee Simple Titleholder Name <br /> Fee SimpleTitlefwlder Address 1 1 <br /> L ot# <br /> Job Address Parcel # <br /> Sub Division 111111111111111111111111111111111111111111111 <br /> Fumigation Tent <br /> ED i <br /> grd Waste Storage - ANNUAL <br /> ❑ Comm Exhaust IGtCherr HoodlDuct <br /> ED Materiel (Tier 11 or RO Facility) ANNUAL <br /> E l Hood Installation <br /> Controlled & [] Hood t+a�l <br /> ❑ <30kw <br /> E3 Emergency Generator> 30 kw n LP/Naha Gas -ANN �e <br /> ❑ Prote =1 Places of Assembly-ANNUAL <br /> Protection - ANN ® ®®Iuner I <br /> Sprinkler ❑ Bum <br /> Fire Alarm - 0 ❑ 0 1 1 D Spariders <br /> Hood Cleaning 'IS. ❑ ❑ I 1 0 Sprirdder System Installations <br /> Hood Suppression Standpipes (SprinIder Sys) <br /> ❑ =1 Torch Roofing/Tar Kettle <br /> . Id Fire Pump Installation ED Waste Tire Storage ANNUAL <br /> Are Pumps <br /> Fire Works Valuation of Project <br /> Flammable Application- ANNUAL <br /> Fuel Tanks <br /> Contactor �►. II Registered L v / N Fee Current 1 Y / N I <br /> Signalise IIMAM-'—'g,„ _ ��� ►�►�..� w I <br /> Address 11111111741100 e-`` L— • ! '1 ' License# i Company <br /> 'RI I Slgnat Registered l Y/ N I Fee Current I Y/ N I <br /> Address lgrwture I License # Company <br /> S atu I I I Registered [ Y/ N I Fee Current I Y/ N I I <br /> Stgn License # I 1 <br /> gCWAN <br /> I <br /> Signature I Company Y/ N I Fee Currant I Y/ N 1 <br /> ig�awre Registered 1 License # 1 <br /> Address I Company I <br /> OTHER <br /> S'tgrSignature I i Reg Y/ N 1 Fee Current 1 Y/ N 1 <br /> License # <br /> Address <br /> Directions: FNI out application completely. with owner) & Contractor sign back of application, notarized (Or, copy of signed contract <br /> If over 12500, a Notice of Commencement is required Akiectianical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation Parcel # - obtained from Property Tax Notice (trttpJ /aPPrai.Pas <br /> Mow 10-14 days for review after submittal date. <br />