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813-780-0020 �/ Glty Ot LephyfhlllS t-I�e Fax-813-780-0021 <br /> � �/ � Permit Application <br /> � � <br /> Date Received Phone Contact for Pertnit 0 3 0�-��' � <br /> Owner's Name �i nr� �a � S�✓� I Ol� IrCJ �'✓-� I�is Owner's Phone Number 0� 3 � � "'f'�� / <br /> Owner's Address (7. 1� �� r ��''���' I � 4 `� � �`'� � <br /> Fee Simple Titleholder Name Titleholder Phone Number �� ��� <br /> Fee Simple Titleholder Address <br /> Job Address U! t o� �� t�r� h Y� I 1 �,�, ���� j�� � Lot # � <br /> Sub Division Paroel # d — � - �� � � � � � D J �� <br /> � Bio-Hazard Waste Storage - ANNUAL a Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> �y emi � er <br /> Sprinkler � ❑ ❑ � � RecreaUonal Bum / � ! o? � � <br /> � <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers � � � / <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installation %� l <br /> Hood Suppression � ❑ ❑ O� � Standpipes (Sprinkler Sys) <br /> � Fire Alartn Instailation � Toroh Roofiingffar Kettle <br /> � Fire Pumps a Waste Tire Storage ANNUAL <br /> Fire Works <br /> � Flammable Application- ANNUAL ( 5.� Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> Contractor Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address q i l�'P1' e7S ' Q�-+.- O..m FI-� 3 License # <br /> ELECTRICIAN Compa�y <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 /> MECHANICA 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 appiicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http:llappraiser.pascogov.com) <br />