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813-780-pU20 uty ot �epnyrrnns rire Fax-si.t-ieo-ouz� <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> � _.. . ., _ _ �». _ .. <. ,� .� <br /> Owners Name L o n � ,�(i t l S Owner's Phone Number �� � <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� <br /> Fee Simple Titleholder Address <br /> � �:��. ,.;,�*�+:��.-w'�: .. _::�€;��� �=$�,.� ��� — .,, -��-� <br /> Job Address ~; y t G'Ce / � �j �V'G �� , �"j Y], /�S �l � � Lot # � <br /> Sub Division Parcel # <br /> w . ,. ..>a- µ� . �;.<�.m:�e. -�.fa ��.waar r .., , - <br /> - - - �: � �+�TM•as��.e:� „� :- ns.�z.�.. - fx„�k< . , _�z <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � 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 �n er �„ <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> a Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q other: <br /> e � ��,.�..�r,�:�..a� ;.„ ;w.�����a.x-:=. v �,. .4-::�-f.��--��� ,�,.: _>.� a���t... �.�.���������-� . , . �,�:��;.�. �;,�� _ , ��;.F <br /> Contractor Company � <br /> Signature (/ ��.I' � � Registered Y/ N Current Y/ N <br /> Address 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/ N <br /> Address License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N Fee Curtent Y/ N <br /> Address 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:/lappraiser.pascogov.com) <br />