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813 -780 -0020 City of Lephyrhnls [ m Fax -813 -780 -0021 <br /> Permit Application i r l i i L � <br /> Date Received IkWeal 2QiQ ,�yl Pho n� Contact for Perrnit 1 1 1 1 1 <br /> 1 C //( ,A '1"f "t Owner's hone Number ( 1 1 1 1 <br /> Owner's Name , t <br /> Owner's Address I (p .,a.VI,c, _ tY / 2 e � V ✓ � t O� ^ ' <br /> Fee Simple Titleholder Name Titleholder Phh Number <br /> Fee Simple Titleholder Address I <br /> Job Address (.0 n g ))) 4 ,_� V KL. �l � • �1 Lot # ( (� <br /> Sub Division I Parcel # 53 A � 4 • 2I -O 0 1 0 - O 1 I Ob - MOO I <br /> Bio -Hazard Waste Storage - ANNUAL I] Fumigation Tent <br /> r Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum { Hood Installation <br /> Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale <br /> I—I Fire Protection Maintenance - ANNUAL Fl Places of Assembly- ANNUAL <br /> f ry (Semis (al Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm E ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning El ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression Ei ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> I - I Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> El Fire Pumps I Waste Tire Storage ANNUAL <br /> El Fire Works <br /> El Flammable Application- ANNUAL ( ( Valuation of Project <br /> 17 Fue Tanks <br /> 0/er: I <br /> ') <br /> Af <br /> Contractor – Company IRM.��. <br /> Signature Registered Y / N Fee Current / N <br /> Address I I License # I <br /> ELECTRICIAN Company I <br /> Signature I Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N 1 <br /> Address I I License # ( I <br /> OTHER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # I I <br /> Directions: <br /> Fill 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 (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) <br />