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10-23-'12 11;42 FBOM-ESSI � 813-931-4048 T-537 P0003/0003 F-082 <br /> . V'v .VVVV�V �(��� V.PermitApplication ' <br /> �nale R�ceived � ` Phone CoMect for Permit 1 q 3$� �-f � I <br /> �r.�:asr�+v�u>_�:s.n:.:c. �.� �:�n:s,�- � �::m,cc�cu;�.:a::n,.x.xa�a�e�.m.�weex.z�Mr•r.�a;.. <br /> ts�setln.u::�:•�lxr„ � <br /> n� <br /> I <br /> Owner��Name j O� �e.Ph f h.�i�S OWners Phone Number $ +3 �d4'a 0 v ZZ. i <br /> OwnsrsAddress ��3 S g�' ,�„� � <br /> Fee Simpie Tiusnolder Name 7iqeholda Phone Number � � � � <br /> Foa Simp1�Titlaholder Addresa <br /> i <br /> i <br /> Job Atltlress J 3.3� �� ��t G7 � I <br /> I <br /> Lot N L�J ! <br /> Sub Divi8lon ParCel# �('Z� ' v�I � '" 13�d�b ••(�1 i� I <br /> a Bio-Hazard Wasts Slorage-ANNUAI � Fumiga6on Tent i <br /> � Comm Exhaust Kitchen MoodlDuct a Maza�dous Matedal(Tier 11 or ftQ Facility)ANNUAL ! <br /> aControlled eurn � Hood Installaaon <br /> � Emergency Generetor<30 Kw � LP/Naturel Ges-Installauon <br /> � Emergency Generator>3o kw Q LP/Neturei Gaa-ANNUAI.Sale ;` <br /> �GI�-e,d,u..l�.C� <br /> Fire Protecdon Maintenence-AiJNUAL �W 1 n f�.5-12 a PleCee oi Assembly-ANNUAL ' <br /> �y emi �n er � <br /> � <br /> Sprinkler � O ❑ ❑ � Recr@atlollal Bum � <br /> Firs AIaMt � d D � Sp8fkle�S <br /> Hood Cleaning � ❑ O D � � Spfi�kierSystem Inste��ations <br /> Hood Suppression � C] ❑ G] � � Standpipes(Sprinwer Sys) � <br /> QFire Alarm instauatian � Tprph Raofing/Taf Ketdb <br /> � Fire Pumps � W�$ts 7ire SWrape ANNUA� <br /> Fire Worke <br /> � Flemmable AppliCetion-ANNUAL Valuation af Project I <br /> � � <br /> Fuel Tanks f <br /> Q Other' j <br /> � <br /> � <br /> Contractor -�y ^ ComPa�Y �r.��eGfY'(h—i c. t G�^� Z s�t.n. '�,n� � <br /> Signawre �7� Registered /N Fes Current Y!N <br /> Address �j'�p a, (Y{�f+ -t!1 ^- � ���1 License# ,C - pouo�i4� ' <br /> ELECTRICIAN Company <br /> S�9�w� �tegistered Y/IV Fee cumsnt Y/N , <br /> nddross �;�„SS� 1 <br /> PLUMBER Company <br /> Signalure Registered Y/N Fse cumsnt Y/N <br /> AtltlreSS Licens6 i <br /> MECHANICAL Comparry <br /> signature Regis�ered Y/N Feo cunoM Y/N ; <br /> AddteES License k <br /> QTHER Cpry�pany i <br /> Signature Rs9is�sred Y/N Fee Curce� Y/N � <br /> ���6 license# <br /> .....�'�j1`n�r�ra*A YI rtfY�sd m�W'F , '�' � <br /> Directions: <br /> Fill out appliCaGon completely. , <br /> pWner$Contractor sign D2Ck of appliC6tion,notarized(Or,Copy Of signed cOnlfaCt Wlth ONme�) <br /> If over 52500,a NoGCe of Commencamant is required(Mechenical work over t5000) <br /> Suppy two(2)sets of drawings with applicabl8 documsrnation �. <br /> Albw 10-14 days for r@view aller submitlal data, paroel M-oblainad from PropeAy Tax Notic�(hqp:l/apprai9er.pascogov.com) � <br /> ; <br /> ; <br /> ( <br /> ; <br /> � <br /> , <br />