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813-780-pp2�� c,ity or�epnyrnins rire <br /> rax-tsi s-itsu-uu�� <br /> - Permit Application <br /> Date Received �--L y-(Z. Phone Contact for Permit <br /> � :..,._ _ _ ..�_ - a r a,. . .. �/ %9G 6�f 6�` <br /> Owner's Name A i n,� -� N t.e,cJ C� /� (��;�� �� <br /> 4��°' Owner's Phone Number u <br /> Owner's Address <br /> Fee Simple Titleholder Name �� � � <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> ` y,. ..*1Puu'��`�>r w°...�-w.�%�^N'4k �.�^ - <br /> s.. ,. _. x r�* -�e�`aF. .- -.-�a-�:$ry".t".T�._q'.�. - - _ <br /> #��,."'m'�f.?s w v •y-;�tw,S�s�'FfR1G°��= <br /> Job Address S a,3� �5� s� Z����S 3"3 S�/� <br /> Lot# � <br /> Sub Division <br /> �: .., �� , �$�,�..,�,_, Parcel# <br /> �-�. <br /> ° - r, �;.�rt:,�e, �.»���.s-*�«�.�-��. <br /> � Bio-Hazard Waste Storage-ANNUAL � �`�� " <br /> � Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ F'acility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � -- , <br /> � LP/Natural Gas-Installation /�- " , <br /> Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale � <br /> � Fire Protection Maintenance-ANNUAL � �f � <br /> Places of Assembly-ANNUAL j <br /> ❑�rTy] emi �n er ❑ � f <br /> Sprinkler ❑ ❑ ❑ Recreational Burn � <br /> ❑ ;� �� /� <br /> Fire Alarm ❑ ❑ ❑ � � Sparklers ''� <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations �.sc-''� ~J� <br /> �..._ <br /> Hood Suppression � ❑ ❑ � C� � 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 <br /> � Valuation of Project <br /> Fuel Tanks <br /> QOther: <br />�* "" , e'^-3»'•.. . . '34�*e,!&iE's��-t3E;L-F. <br /> . xixUai�. . a_ ' ' . , _ _."�^Y'...�7'..'�.�'y,•^a:.4'�Xti*.��.,. _ <br /> Contractor �.._�._--- �'.a�.� �..:.��,�:� <br /> Signature . Company �� .�,� � _��� <br /> r Registered Y/N Fee Current Y/N <br /> Address Q p _ .Ll Q�� � 3 G� License# <br /> ELECTRICIAN <br /> 5ignature Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br />'LUMBER <br /> iignature Company <br /> Registered Y/N Fee CuRent Y/N <br /> Address <br /> License# <br /> AECHANICAL <br />�ignature Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> 1THER <br /> ignature Company <br /> Registered Y/N Fee Cu�rent Y/N <br /> Address <br /> License# <br /> irections: <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 htt //a <br /> ( p: ppraiser.pascogov.com) <br />