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313-7£0-0020 C��QfZ ephyrhilis F'��� ra±-oio-rov-�vti <br /> P�rmit Appfication _ _ <br /> Dats Received Phone Contact for Permlt � .�� <br /> ��'.o�fi�.F,:r`:'r.� .K_:.: ._..� _..k_.,.,....:,.,�,..... 3�'.�'s7��."�a3'6.�:a�s�B�T.�� c� .._,_ s:�_... . . . .,.._....�.._-,._.<_ �...-.�.�_x...�_ <br /> Ownsr's Nam� `� � �(„sL�J� � (.�- Owner's Phone Number � l p L1 Ov <br /> Own°rs Address Z S ��'U �"()'C. l,t� g4� �'Z d L <br /> Fee Simple ?itl=holder Name Titleholder Phon= Number ��� <br /> F=e SimplaTitlefioider Address <br /> �ai�&��'°� >. �,:".::�::��"�.�`'�x• ��r.�-�+{.� �'�`�s�� <br /> Job Address l3`i�i G/�-L �LJ1� zC.�hl'� 1�'1LLS FL lot� �] <br /> Sub Division Q..�� �(,d„S Paroel n <br /> -� • s - <br /> T <br /> � Bio-Hazard Wast= Storage -ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier If or RQ Facility) AIJNUAL <br /> Q Controiled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emeraency Gene�tor> 30 kw � LP/Naturel Gas-ANNUAl. Sale <br /> � Fira Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> tr y erni Qn ar �''') <br /> Sprinkler � � ❑ ❑ � RecreationalBum ���� / <br /> / <br /> Fire Alarm � ❑ ❑ ❑ � � Sparkl=rs <br /> Hood Cleaning � ❑ � O� � Sprinkler System fnstallations <br /> Hood Suppression � � ❑ ❑� � 5tandpipes (Sprinkler Sys) <br /> a Rre Atarm instatlation � Torch Roofrng/Tar Kettle <br /> Fira Pumps � Waste Tire Storaga ANNUAL <br /> Fire Works <br /> Flammable Appfication- ANNUAL Z,� .pC) Valuation of Project <br /> Fuel Tanks <br /> � Otiier: <br /> �^,�a� �;.� <br /> ConVactor Company <br /> Signature Regist�red 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 1 N <br /> Address License � <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> oTH�Ft .> Y . Company ��� F ) <br /> Signature Registered N Fee Current � N <br /> Address , 0 L. � � License 7 C.) (�j �$ Z,pl7b °�i�7' <br /> .. x . . .._.:=...s�.....-°- ,._:� _-._ . _ ._ _.�_.:_,�_.: - <br /> - - - ..� ..� >_.x.�._..._..�. - - - -- -�:..�..�.....aµ...tt ���,�� <br /> Y Directiors: <br /> FlII out application completely. <br /> Owner 8 C.ontractor sign back of application, no;ar;zed (Or, copy of signed contrect with owner) <br /> lf over 52500, a Notice of Comm=ncement is required (Mechanicat work over 55000) <br /> Supply two (2) sets of d2wings with appiioable documen;ation <br /> Ailow 10-14 days for revi=w aft=r submi:tal date. Parel r- ohtained from Property Tax Naice (http://aa�2iser;oascogov.rom) <br />