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10-23-'1c 11;42 F�OM-ESSI 813-931-4048 T-537 P0002/0003 F-082 <br /> . ...,. ,.... ...... �'/� �[v ...y ...�..r...�......... .... <br /> • � � Permit AppliCation <br /> Date Recnived Phan�Ca►tact for Permil I 3 g3 S '7`f��7 <br /> a+:nr�raswn� .a�aEC+#tcbr�c:r«.•• <br /> Owners Name l.► d� LZ�h f 4'�+��S �.1�P�../ Owner�s phone Numher B i� 7 c� �l)(o`� <br /> Owners Address ��j�� O-f'1" ��,�-�,-� � <br /> � <br /> Fee 3imple Tnleholder Neme Titlsholdsr Phone Numbe� � �� C� ' <br /> Fee 3imple TiGehol�ar Address � <br /> i <br /> JobAddress 5.�y1 �� �Ft4'�' � ; <br /> Lot�k � <br /> Sub Division Pa��� � <br /> i <br /> � eio-Hazerd Wes1a Stordge-ANNUAL � Fumiyation Tent <br /> � Comm Exnausl Kitchen Hood/Duct � Hezardous Material(Tier II or RQ Feciliry)ANNUAL � <br /> � CoMrolled Bum Q HOOA In3l�Ila�ion � <br /> � Emergency Ganerab�<36 kw o LP/Nalunl Gas-Installation � <br /> � Emergency Generator>30 kw �C.�d.�-� �v'� � �p/Natural Gas-ANNUAL Sala � <br /> Fire Prateq;on Msintsnence-ANNUAL �� '��'+t� � � <br /> Placss of Assembly-ANNUAI. � <br /> ❑� m� � er <br /> Spri�kier ❑ O 0 � 1teCreBfipnal Burn � <br /> Fire Alarm � p [] p��� � Spa�lers <br /> Hootl Cleaning � O d p � � gpr;nkler System Inslallations <br /> Hood Suppression � Ct O O � � Stendpipes(Spfw�clw Sya) <br /> � Fire Alarm Installation � TofCh ROOrynglTar KgNla <br /> � Fire Pumps � W��(e Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammabfe Application-ANNUAL <br /> � ���1 Valuation of Prdject <br /> FuelTanks <br /> � Other: <br /> � <br /> Co�haCtOr � CompanY Mi c St t.1..t� �. S�tn.f"L�,. � <br /> s;9"gi°'� �• Registered N Fee Current Y/N � <br /> AddreSS !D . q, { (Ytti { 1t f� r" c..G4 3$b�`� LicenseA -p�pp�yd <br /> EL�Ci'RICIAN Company � <br /> Signature Rs9istercd Y/N Fee Cutrent Y/N <br /> Addrese License� � <br /> PLUMB�R Comparry i <br /> S�ynature Regisief¢d Y/N Fee Current Y/N <br /> Address �����* <br /> MECMANICA6 Company <br /> Signature Reqisteretl Y/N Fee Cunent Y/N <br /> Address ; <br /> license S <br /> OTHER � <br /> Company � <br /> Signalure <br /> Res�srerea Y/N F..c�r� Y/N <br /> Adtlrass License# � <br /> Dif6Ctions: . � <br /> Fill out epplicetion completely. i <br /> ownsr&Contractor sign back of applicalion,notanted(Or,copy of sianed nonuact witt►owner) � <br /> If over=2500,a Notice of Commsncament is required(Mochanical work over l5000) F <br /> Supply Iwo(2)eeta of drawings with applicabie dxumsMation i <br /> Allpw 10-14 days far rBView aher submittel dete. � <br /> Parce�#-obtained from PropeRy Tax Notice(hllp:Neppreiser.pascogov.cplYl) I <br /> i <br /> i <br /> I <br /> i <br />