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ai�-iau-uulu c;ity ot �ephymuis rire Fax-813-780-0021 <br /> Permit Application �'(f,� �}c f�i'/� <br /> Date ReceiNed j 7 � 1 Phone Contact for Permit �i � 3 �� L� <br /> Owner's Name �ST /G Owner's Phone Number � �� �s � ! / �� <br /> Owner's Address c� [ 7�J� C=' /� � / S 3 3 S�JZ <br /> Fee Simple Titleholder Name Titleholder Phone Number ��� <br /> Fee Simple Titleholder Address <br /> ,. � � <br /> Job Address 3q � �-�i z `/S 3 3 5�{Z Lot # �� <br /> Sub Division Parcel # <br /> - ,�. <o. .. . , <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Instaliation <br /> � Emergency Generator > 30 kw LP/Natural Gas-ANNUAL Sale �� <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL � J S <br /> �y emi �n er � <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑�� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Toroh Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other. <br /> r , .. �. ._,., .<. , - �r . . . . .. ,._.... .� �� .. . u <br /> Contractor � Company <br /> Signature 1�-�-� �- Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature � Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <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 (httpJ/appraiser.pascogov.com) <br />