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�,izy oi �epnyrnnis rire rax-es�s-iau-uuzi <br /> Chris Shultz Permit Application /' <br /> � SystemslntegrationConsulant l���S S�'�u <br /> Security Solutions� PhoneContactforPermit ,/� � � <br /> Stanley Convergent Security Solutions, Inc. � i ���' � �'`��"^T Owner's Phone Number ��� <br /> 5610 W Sligh Avenue, Suite 104 ��� p�., �l lls � � 3 <br /> Fampa, FL 33634 <br /> Phone 813.241.3500 Fax 813.929.7219 � � � <br /> Cell 813.416.1824 Titleholder Phone Number <br /> CShultzC�Stanleyworks.com ■ vvww.stanleycss.com <br /> FixEFZOOaoass,EFa000iii� EFmoosizEFaaom�z :`�``�� ' n �` ° ""�'�-' ` - � ` <br /> � a..� ��, � i u.s � 33s� �- �ot # 0 <br /> Sub Division Parcel # <br /> . _ .,�•r:�. _ _, .>....>...,., w..... .x > �:, . r,,. � _.. . . . <br /> a 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 � LPlNatural Gas-Instaltation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL �/�(_ <br /> � emi �n er � �`� <br /> Sprinkler � O ❑ ❑ � � Recreational Bum <br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Su ression � ❑ ❑ ❑ � � 5tandpipes (Sprinkler Sys) <br /> Fire Alartn Install Lon � Torch Roofingffar Kettle <br /> ire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> � FlammableApplication-ANNUAL '} p ValUatiOn Of PfojeCt <br /> � Fuel Tanks <br /> � ' • <br /> + ..'°.oe; a3;�d, . ., . .. . �. . ,., . .. ., ie:,S:.' .,. -'<dAf: k "�a�a� r,?::°�e. � . ., . . ..a �" . . . ,. <br /> Contractor Company ,�"'rA1Jt�ry rJ✓=e6e`ur � L�UT`l S1tu r <br /> Signature Registered Y Fee Current Y/ N <br /> Address � 0 (J �-i � ✓� �A M PA �r � 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 /> _ ..... _ c. in .R.....:.�Fa.r R.z ' Av! B3fff. ._ . . ._. ..... , .. q, . ^ <br /> Directions: <br /> Fill out application completely. <br /> Ovmer 8 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 />