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813-780-0020 ,/��,,p �� /l�`�r� �ity or �epnyrnms rire <br /> � ! Permit AppliCation rax-a�s-iuu-wz� <br /> Date Received � <br /> � '�'^°R Phone Contact for Permit 6 <br /> , � w,... �� <br /> Owner'sName }�/¢L.1—/�}il9CC �,�/(J/�C�-r � z— ' `° � Y <br /> F ��`� Owner's Phone Number g� 3 � {,J[ � S�p� <br /> Owner's Address 6aS/ Fn �� 2��� �__ o 6 <br /> � �E�°f{ �ff /t1-S �L - 33�`"�� <br /> Fee Simple Titleholder Name �� � <br /> Fee Simple Titleholder Address C Titleholder Phone Number � <br /> ° - ;-s�:�a�z- ��.. � x � _ <br /> JobAddress � � �� � �� ���;"�;;n'w - Y.�;. ;�;;,_°�- <br /> Sub Division Lot # 4, �� <br /> s • �.yr,:� ; . .,�°���� ��. Parcel # <br /> ���i���>... � �- ,� ��--�-x. . <br /> � Bio-Hazard Waste Storage - ANNUAL ' 3 ��� :YK � rv � �� .�� <br /> � ����x.�.;r�.��-���,�.. <br /> � Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct <br /> � a hlazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Burn <br /> � Emergency Generator < 30 kw Hood Installation <br /> � Emergency Generator > 30 kw � �P�Natural Gas-Installation <br /> a Fire Protection Maintenance - ANNUAL ' �P�Natural Gas-ANNUAL Sale <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 � � � � ❑ <br /> � Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation � <br /> � Toroh Roofing/Tar Kettle <br /> Fire Pumps a <br /> � Fire Works Waste Tire Storage ANNUAL • <br /> � Flammable Application- ANNUAL <br /> � Fuel Tanks Valuation of Project <br /> Q Other: <br /> .. p'$.:�'� _ '.''.fiL.w�'n£I�.} t?�'; <br /> ...: a:e' ' '�.. -:��.. r.8 R�i r ;�' : <br /> Contractor � ` �s`_. � - -.��„.�,.m �,.� � �*w��.� <br /> a�� �=::��^� �r: , �u;:� „ �,w <br /> 5ignature Com an ������ <br /> dL2 P Y <br /> Address Registered Y/ N Fee Current Y/ N <br /> :LECTRiCIAN License # <br /> iignature Company <br /> Address Registered Y/ N Fee Current Y/ N <br /> 'LUMBER License # <br /> ignature Company <br /> Address Registered Y/ N Fee Current Y/ N <br /> ECHANICAL License # <br /> gnature Company <br /> Address Registered Y/ N Fee Current Y/ N <br /> fHER License # <br /> �nature i Company <br /> Address Registered Y/ N Fee Current Y/ N <br /> ections: License # <br /> Fill out application completely <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contrect 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 />