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s��-�ao-oo2o C:ity Ot Lephyrt1111S tire Fax-s��-�ao-ooz� <br /> '� � Permit Application <br /> 0 �47 4�7 <br /> Date Received Phone Contact for Pertnit � f <br /> Owner's Name ���'' � 5t'r0 Owners Phone Number �� � �� a'�Fja- <br /> o�,ers Aaa� `�' o��. !? 0 7 a `i'czmp�z. FL 3365� <br /> Fee Simple Titleholder Name Titleholder Phone Number ��� <br /> Fee Simple TiUeholder Address <br /> Job Address ���J �Tt�'.,� ("�j ( Vd� .cx./i41 Y'�'i I f j;� FL 3 3� Lot # � <br /> Sub Division Par�el # <br /> a Bio-Hazard Waste Storege - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hoad/Duct � Hazardous Material (Tfer II or RQ Facility) ANNUAL <br /> � Controlled Bum Q Hood Installation <br /> Q Emergency Generator < 30 kw � LPiNatural Gas-Installation <br /> � Emergency Generator > 3U kw � LP/Natural Gas-ANNUAL Sale <br /> Fire ProtecUon Maintenance - ANNUAL � Places of Assembly-ANNUAL J � n� <br /> � emi � r J � i1 <br /> Sprinkler a ❑ ❑ � � Recreational Bum � � � <br /> Fre Alartn � ❑ ❑ ❑ � Q Spaeklers <br /> Hood Cleaning �❑ � O� � Sprinkler System Insiallations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alartn Installation a Toroh Roofing/Tar Ketde <br /> Fre Pumps � Waste Tire Storege ANNUAL <br /> Fire Worlcs <br /> Flammable Applicatlon- ANNUAL � a� 5. "=' Valua�lon of ProjeCt <br /> Fuei Tanks <br /> Q Other. <br /> Contractor Comparry X- ! r� �� �^ <br /> signawre � J � Registered N Fee CuRent N <br /> Address IOpr �' � L License# /o c�-OOd � $ <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Curterrt Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address Ucense # <br /> MECHANI 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 Ucense # <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor aign back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencemerrt is requfred (Mechanical wurk over a5000) <br /> Supply tvw (2) sets of drawings with applicable dxumentation <br /> Allow 10-14 days for review after submktal date. Parcel #- obtained from Property Tax Notice (httpJ/appraiser.pascogov.com) <br />