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<br /> � Permii Applica�ion
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<br /> Dafe Received � PF�one Coniact for P�rmit
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<br /> O�vn��s �lame 1J� Ownet's Phone Numb g� 3 6 2 6 ` 5 4 8 2
<br /> ow�? 4701 Oak Fair Blvd TfiMPA FL 33610
<br /> Fee Simple Titfei�ofder I�ame � Titleholder Phon� Number �� �
<br /> Fee SimpleTittef�olderAddress
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<br /> � Bio-Hazard Waste Storege - ANFtUAL � Fumigation 7enf
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier I[ or RQ Facilify) ANNUAL
<br /> � Controfled Bum � Hood fnsfalfafion
<br /> � Emergency Generator < 30 kw � LP/Natural Gas-Instaflafion
<br /> Emergency Generator � 30 kw � LP/Nafural Gas-ANHUAL Safe
<br /> � Fire Pratection Maintenance - ANhIUAL � Places of Assembly-AP(DtUAL
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<br /> , Sprinkfer. � ❑ ❑ ❑ � � Recreafional Bum /„
<br /> , Fire Alarm � d ❑ �� � Sparkfers '1� I � � �!
<br /> Hood Cleaning � p ❑ ❑� � Sprinkler Sysfem Insfafla4ions `
<br /> _. _ , Hood Suppressio� � ❑ ❑ ❑ � � Standpipes (Sprinkier Sys)
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<br /> . . - :.;. Fire Rlarm insfallafion � � � - i ar ' • " - - -
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<br /> , ,;: � Fire Pumps Wasfe Tire Storage AHNUAL
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<br /> Fire Works
<br /> � -,-,,; � ; FlamriiabfeApplication-ANNUAL Valuation of Project
<br /> ' ^ �� Fuel Tanks � ' '
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<br /> Contractor Company � �N'�' � � �r�v.�, C.{
<br /> Signafure ' Registered Y/ IV Fee .CuRent Y/ N
<br /> Addres§ License # •
<br /> ELECTRICfAN `--.` ' .,' . - " - • ` . -- Company -
<br /> Signafure - " ftegisfered �: Y/ N . Fee Current Y/ N �•
<br /> Address License # � - .
<br /> PLUMBER . _ ` , Company • -
<br /> Signafure Regisfe ed Y/ I� � Fee Currenf 1' /. �j'
<br /> Address License # �
<br /> MECHANfCAL Company
<br /> Signafure Registered Y/ N Fee Currenf Y/�I
<br /> Address . ' License #
<br /> OTHER Company .
<br /> Signature Registered Y/ N Fee Current �( /�(
<br /> Address Licerts #
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<br /> . Filf out applicafion compfefely_ ,
<br /> _: Owner 8� Contcacfor sign back of applicaiion, nofarized (Or, copy of signed cantracf with owner) .
<br /> (f over $Z500, a Notic= of Comrnencement is required_(Mechanieaf wor{c over $500Q) .
<br /> -_ - Supply fwo (2) sefs of dcawings w[fh applicab[e documenfafion �
<br /> ___ . _ Altod�t 10-f4 days for review at�er submitFaf date. Parcef �#- obfained frnm ProPa�}r Tax t�iofic2 (F��fp://appraiser.pascogav.com}
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