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si�-�so-oo2o c:ny ot cepr�ymms r�re <br /> Fax-813780-0021 <br /> Permlt Applicatfon <br /> Date Received Phons Cor�:t for P�rtnit �� �� <br /> Owners Name r �+ l� 1�1 Ownsh Phons Wumbsr � J �a- C� <br /> Owners Address Q � c <br /> Fee Simpb Tltleholder Name TitlsFqldsr Phone Number U� C <br /> Fee Simple TiHeholder Address <br /> Job Address ( �� 'T Y Y t � ��J �-- � 3�, �i Lot # C <br /> Sub Division Partxl !! �o� - � ` � � �O� �- �� j� - �. � <br /> Q Bb-Flazard Waste Storage - ANNUAL � FurniysUon TeM } <br /> � Comm Exhsust latchen Hood/Duct � Flundous M�tsria� (Tbr 11 or RQ Faeiltty) ANNUAL <br /> � Contr�olled Bum � fbod Installatlon <br /> � Emar+pencY Genscator < 30 kw LPRJ�U�rai C3es-Insblletlon <br /> � Erns�gs^eY Gsnsrator> 30 kw LPMabwai G�s,ANNUAL Sals '-- <br /> Fire Pro�eWon Mainbrnnce - ANNUAL Pleces af Asssmbly,ANNUAL / <br /> � � � Sprinkler O O Rea�o�l Bum � /� <br /> Fire Alarm �❑ ❑ O � S�*� � h � <br /> L�1 �\ >� � <br /> Fiood Geanin9 � O 0 D� SpriNdsr Sys6sm installatlons �- <br /> Flood SuPPrsssion � ❑ ❑ ❑ � � SfsndPlPes (3Prinlde� Sys) <br /> a Fre Alartn Ir�laUon � Taoh Rootinp/Tu K�tle <br /> fiire P�m�ps � Waste Tiro Storage ANNUAL <br /> Rro Works <br /> Flammabb Application. ANNUI►� Veluetlon of Projed <br /> Fuei Tanks <br /> Q Other. <br /> Contractar Corr�any � ✓1C� <br /> Signature V��� Reg�sterod Y N Fee C�uront Y N <br /> Address � c� � Liosnss # (o o.. � <br /> ELECTRICWN � <br /> S�g"etu''8 Repistsrsd Y/ N Pes Curnent Y/ N � <br /> �"� uanse # <br /> PLUMBER �� <br /> Sig"etu''e Rspfs�d Y/ N Fee Curtsr,t Y/ N <br /> �" Licsnss # <br /> MECHANI � <br /> signaturs Rspist.r�d Y/ N Fes cumsnc Y/ N <br /> Addross Lkeras # <br /> OTHER �� <br /> �" 8Y1f° RspbUe�sd Y/ N Fes Cunsnt Y/ N <br /> Address Ucsnse # <br /> Directions: � . � ., <br /> Fiil out spplication compl�tsly. <br /> Owrwr d� Contracbor sipn b�dc of apaieatla�. notariz�d (Or� coPY af sipnsd oontrad wNh awnsr) <br /> If over 52500. a NoUoe of Commsnosment fs rsqu�sd (�Aer.har�ical work ovsr 55000) <br /> Suppy two (2) sets of drawings wNh appHcabls doax�Uon <br /> Allow 1 Q14 days for roview aRsr submkf�l dabs. Pareel �- oDLined from Properly Tax Nofios (M�J/appraiasr.pascogov.com} <br />