Laserfiche WebLink
813-780-OD"ZO �iry or �epnyrrnus rire rax-aia-iau-uun <br /> Permit Application <br /> Date Received / Phone Contact for Permit <br /> � _ . ,.,... . v , . , y,.. � � <br /> Owner's Name �' �j � - �� , �6 � Owner's Phone Number �/ 7o g � � p <br /> Owner's Address �,�p �� �P � ` � � S- <br /> Fee Simple Titleholder Name Titleholder Phone Number � �� � <br /> Fee Simple Titleholder Address <br /> , • - _ . ,-. - _ _ ; 7;,' m s';RS r�'»'s.':�' 'R°�:�a94'�.�. ° ,_; • - y „ � , ..^�+-�+;,... , �y,a� <br /> Job Address � � <br /> Lot # <br /> Sub Division Parcel # <br /> � � w .v.� �.. i4t'!'�'q+:45Y. , .�A�� aav � <br /> _ .r.r��.s ���<X� R._. . . sa8v=+-v�h.^=��:is.: ��� , _ _ _ ;�.�"�.r. _ a�.�,a�a!a�a-m..�„.-�,.� .�,...x.,. <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Instaltation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> � emi � er � / 2 C� / � <br /> l � <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum <br /> Fire Alarm O ❑ � � � Sparklers <br /> Hood Cleaning ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � O ❑ ❑� � Standpipes (Sprinkler Sys) <br /> � Fire Alarm installation � Torch Roofing/Tar Kettle <br /> a Fire Pumps � Waste Tire Storage ANNUAL <br /> a Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> a =-:�.�;¢=�: . �. ;��a��.� •�� _ . �.-����a�-k�����.�-�-.- -. , �-.��..�:�-�;;:��,,�r ,��°µH.;:,��s���,. _.�.u� <br /> Contractor � Company �. ti <br /> Signature C�� Registered Y/ N Fee Current Y/ <br /> Address p ,� ' ' �' � - �,/ 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/ IV <br /> Address License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> t. <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 applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />