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6 i a-i au�vu�u <br /> ��ry ar�epnymnrs rrre <br /> Permit Application ��-�13-780-002i <br /> ate Received ��"� <br /> - Phone Contaci for Pertnit '�a1 <br /> wner's Name S .�Z 3 'y 3 c�U <br /> ��v rr"vS'i' �ANI< <br /> Owner's Phone Number br 1 3 �7 g p �/y I <br /> wner's Address S 4 3 5 G A�S (;Lv D, �� <br /> �y�K�L�s, �l. 33542 <br /> se Simple Tttleholder Name t-------_J r�� <br /> 3e Simpie Titleholder Address Titleholder Phone Number � �-�-�--�.�J <br /> vbAddress 543s (�ALI 31.VJ�.� ��pHyr►-��`�S c <br /> , • �. 3 3 S�-i 2 � <br /> lb Division Lot# <br /> Parcei# <br /> � Bio-Hazard Waste Storage-ANFEUA� Q <br /> � Camm Exhaust Kitcnen Hood/Duct Fumigatlon Tent <br /> CJ Controiled Bum o yaz��ous Material(Tier 11 or RQ Facility)AlVNUAL <br /> � Emergancy Generator<30�,,, Hood installation <br /> oEmen9ency Genarator>30 Icxr � � tj � � LPMaturat�as-Instalfatlon <br /> � Fire Protecti�Mairrtenance_qf�►�UAL l+17�""`� o �P�atural Gas,ANNUAL Sale <br /> � Places of Assembly,ANNUAL <br /> �� 8fi � er <br /> Sprinkler � p O � <br /> � Fire Atarm ❑ Recreatlonal Bum <br /> � Q � � ,` � <br /> � Hood Cleaning n � SParklers <br /> Q � � � � Sprtnkler 5ystem Instatlations <br /> Naod Suppressfon p � � � � <br /> � Standpipes{Sprinkler Sys) <br /> Fire Alarm Instaliation � <br /> F��p��Ag Torch Roofing/Tar Kettie <br /> Fire Vyorics � Waste Tire Storage ANNUAI <br /> Fiammable Applfcation-ANNUAL � <br /> Fuef Tanks �� Valuation of Projec# <br /> [� Other: <br /> mtractor <br /> gnature Company 5,,�.2� In�C.-----------_,._.__,. <br /> Address Registered �+/(y�r F�C'-`""'���t— Y/N <br /> .ECTRiCIAN <br /> License# �� _— <br /> gnature Company --_._ <br /> Address Registered Y/N Fee Current L/N -""� <br /> .UMBER l.lcense# <br /> gnature �m��Y _.�._,.,_,._�, <br /> _ Address Regisfered Y/N Fee curcent Y(N � <br />�CHANICA Llcense# <br />�nature Company ---- <br /> Address Registaied Y/NT Fee Current T-Y/j� '�-------� <br />�ry� License# _� <br />��re Company <br /> Address Ragistered Y/N Fee Cumnt Y/N <br />�ections; Licertse# �-"""-"-----� <br /> Fill out appl(cation compietely, <br /> Ow�er&Contractor sfgn back of$pp���aUon,notarized(Or,copy of signed contract with owner) <br /> (f over$25D0,a Jdofice ot Commertcement is raquired(Mechanical work over a5000) <br /> Supply iwo(2)sets of drawings y,4th applicabie documentation <br /> A1��w 10.14 days for revjeyy after submittai date. Parcet#-obtalned from Property Tax NoHce(http;//appraiser.pascogov,com) <br />