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813-780-002U <br /> c;ity or cepnyrnms rire <br /> rax <br /> _ _ Permit Application <br /> Date Received Ci�,�- 7 <br /> " � -. . . - � Phone Contact for Permit � � <br /> Owner's Name �� <br /> Ovmer's Phone Number �� S 7 <br /> Owner's Address <br /> Fee Simple Titleholder Name � �� �� <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> � � - -- .�e.r;,�, - - ;...,.,.�;.,� .�T��:.��.:vY.��:�r-�_ <br /> :'��._ ;„y�,�,.,,�a , r , <br /> - zt - ,+�a . - ,�, — <br /> Job Address � �! G` <br /> � - �'�°� �s�,_ . . ,�_...,..�,.��, .�.�� <br /> Sub Division <br /> Lot # �� <br /> ► � �., �,;,; .� Paroel # <br /> '�, �'������ �*��� {,-� �.�:.ro� y , ,�..,.�. <br /> � � s.��•, -���� �; <br /> Bio-Hazard Waste Storage - ANNUAL � '�'� a <br /> Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Burn � <br /> � Hood Installation <br /> Emergency Generator < 30 kw � <br /> � LP/Natural Gas-Installation <br /> Emergency Generator > 30 kw � <br /> � LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL � <br /> Places of Assembly-ANNUAL <br /> ❑ � Y emi � er ❑ <br /> Sprinkler � � � <br /> ❑ Recreational Burn <br /> Fire Alarm � � � �� ❑ <br /> � Sparklers <br /> Hood Cleaning � � � �� ❑ <br /> � Sprinkler System Installations <br /> Hood Suppression p � � � ❑ <br /> � Sta�dpipes (Sprinkler Sys) <br /> Fire Alarm Installation � <br /> � Torch RoofinglTar Kettle <br /> Fire Pumps � <br /> ❑ Waste Tire Storage ANNUAL <br /> Fire Works <br /> � Fiammable Application- ANNUAL <br /> � Fuel Tanks Valuation of Project <br /> Q Other <br /> a _: , r�z��� _. �, r� �:. .. �kz;�. .� <br /> '?t�.�5�;,� - s�.k^� , .�tax,�- <br /> Contractor �`�'"��:°.� ��� : . , . �..;�.w,�-�. �.�s�� <br /> �x,:*+a�.��caasr�'z�^.�, �:3:a;,�'^na.�:�:�^•,�+;�F.�+;�r.,�:- <br /> Signature v Company � <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> °LUMBER License # <br /> iignature Company <br /> Registered Y/ M Fee Current Y/ N <br /> Address <br /> AECHANICAL License # <br /> iignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> �THER <br /> ignature Company <br /> Address <br /> Registered Y/ N Fee Current Y/ N <br /> irections: License # <br /> Fill out application completely <br /> Owner 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 applicabie documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice htt //a <br /> � P� ppraiser.pascogov.com) <br />