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813-780-0020 (;lty 01 L.BphyfhillS F-If8 Fax•813-780-0021
<br /> Permit Application
<br /> Date Receive�i F'hone Contacl for Parmit
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<br /> Owner's Nama � Owners Phone Number
<br /> O►vr18r'8 AddfBSS r
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<br /> Fee Slmple Titlehoider Name TiGeholder Phona Number � � �
<br /> Fee Simple TiUehotder Address
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<br /> �ob naa��s ��l - c.�� - _ TU
<br /> Lot#
<br /> Sub Dlvleion Parcel#
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<br /> 8io-Hazard Waste Slorage-AMIJUAL � FumfgaUon Tent
<br /> Q Comm Exhaust Kitchen HoodlDuct a Hazardous MateAal(Tfer II or RQ Facflity)ANNUqt
<br /> a ConVoited Bum � Hood InstalleUon
<br /> � Emergancy Generator<30 kw � LPlNalural Gas-Instaitation
<br /> � Emergency Generator>30 kw � LPlNaturai Gas-ANNUAL Sale
<br /> aFir�e Protection Maintenance-ANNUAt, a Placea of Assembiy-ANNUAL ��
<br /> � em � er �
<br /> Sprinkler � � � � � � Recreational Burn 2%
<br /> FireAlarm ❑ ❑ ��
<br /> � RR � � Sparkisrs
<br /> Hood Cleaning � ❑ D O � � Sprinkler System Installa6ons
<br /> Hood Suppression � p ❑ ❑ � � Slandpipes(Sprinkter Sys)
<br /> QFire Alarm Installafion � Totch RoofinglTar KelUe
<br /> Fire Pumps � Waste Tire Storage ANMUAL
<br /> f�(e WO(k6
<br /> Flammable ApplicaGon-ANNUAi.
<br /> Vatuation of Project
<br /> � Fuei Tanks
<br /> Q Other:
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<br /> Cont�ctor /1��`-Y.�-� Company �m
<br /> Signature � tte9is�ered Y 1 N Fee Current Y i N
<br /> Addrosa "; ��)^ v �� license# �— �
<br /> ELECTRICIAN Company �
<br /> Signature Reglstered Y/N Fee Curcent Y/N
<br /> Address
<br /> , License#
<br /> PLUMBER Company "`
<br /> Sipnature Re8lstered Y!N Fee Curcent Y 1 N
<br /> Address Ucense#
<br /> MECMANICAL Company �
<br /> Sfgnature Regfatered � Y/IV Fes Current �Y!1�1
<br /> Address License# ��
<br /> OTHER Company
<br /> S(gnature Repfstered Y/N Fea Current Y/N
<br /> Address
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<br /> Ftll out applicaUon compielely.
<br /> Owner&ConUactor stgn back of applicatlon,notarized(Or,oopy of slgned conUaci wilh rnmer)
<br /> If over$2500,a Nodce of Commencement(s requlred(Mechanlcaf work over$50U0)
<br /> Supply hvo(2)sets of dravdngs with applicable documentaUon
<br /> Allow 10-14 days for revlew aRer submittal date. Parcel#-obtained iram Properiy Tax Notice(http://appraiser.pasco0ov.com}
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