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813-780-002U t;iry ot�epnyrnuis rire Fax-tS�d-/8U-UUY1 <br /> Permit Application <br /> Date Received � � �Q'� Ov2��i�J�o2 Phone Contact for Permit c� �J C� / 3 <br />� . _ ° r , <br /> L�s � l O f �� f�7-�-1 g l3 �S�5 `�3�.5'l <br /> Owner's Name .c_ Ovmer's Phone Number <br /> Owner'sAddress 7"�Q /J�� "/ ��I� / /V/r �-L 33�7"� <br /> Fee Simple Titieholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br />� �.�,a.;„ .�.���,,�r�r��€�-�-- s:��,: ,�: :: •-�.�;. .F_ ,°:��:�n���x�-. _.;�s��-•��.,� — , ...,n�, <br /> Job Address ��L� �N Q���D��VGI�T�µ� SG��t� �L'L B L-VU Lot# � <br /> Sub Division Parcel# <br /> t l ,.. a,r s,.�;',P�.,�ae!%r.�- .c•._ .:,�p-x�g�r±^:a,_ ,..,�--.¢� ",,,- ,. .._ ;. �.isri.+�n.,-.,_�°:�,-� , -_z�e�aa.�.s:�LPkM.+��.sa=: ,p.�.-:, <br /> _ _ _ _ - ��+'iK'e,a'iTf' r ��"9W' -�#'2n.�. <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Instaltation <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 � ❑ ❑ O � Recreational Burn <br /> Fire Alarm � ❑ � � � � Sparklers � <br /> Hood Cleaning � ❑ � ❑ � � Sprinkler System Installations �t�► ,'r13 <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) ( `/ " <br /> � 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 />! r 'i�&3^ >�r ' . i`sa-. M. _".''R.p°«;�$.'�:"Adt.`4"; . 'i,-d".9`..•:s,..�..R'<`^',d^'-`n l:!-na'x'S'*' '.et.'5..,�,�.t�> . � .. z ,. .. f..,...rori,°4-:.".8i�g�44+e-';RI!R9±C'"-"4`)5i,p�';i`Rnn.S�1'P4'�'+.ri�'=.'_. FS+dh'°�°�Sx"m',4:'.'�h"+a'�&'.." <br /> Contractor �'J� Q/f� /^ Company .� <br /> Signature �'� � Registered Y/N Fee 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 /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> EDirections: <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 applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http:!/appraiser.pascogov.com) <br />