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From: 06/06/2013 14:33 #317 P.001/002 <br /> s»-78o-oozo Ci of Ze h <br /> Ly p yrhiils Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Pertnit °� <br /> � Gt '.s 0 /�� <br /> Owner's Name " O'ibfiers Phone Number � C�°�� <br /> Owner's Address �'� � <br /> Fee Simple Tideholder Name Titleholder Phone Number C� �� � <br /> Fee Simple Titleholder Add►ess <br /> 3ob Address �/T"� S�z-��`� Lot# � <br /> Sub Division Patcel# <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigadon Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(fier H or RQ Facilily)ANNUAL <br /> � Corwolled Bum Q Hood�nstallation <br /> � Emerpency Generator<3p kw a �P/Natural Gas-Installation �( 2�VJ <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Ssla � '�.r <br /> � Fire Protection Maintenance-ANNUAI. ���� <br /> Places of Assembiy-ANNUAI. <br /> er � <br /> SpHnkler � ❑ ��p � � RecreaUonal Bum y�//l`��^�'��1 '(,(,�✓� <br /> Fire A{artn � � � � S�, _ +;� U' " ��/ <br /> ❑ ❑ � Spariclers �� ��� �b f r <br /> .�� <br /> Hood Geaning ❑ ❑ ❑ � Sprinkler System InstaAations Q � � <br /> t�ood SuPP�ession � f] ❑ ❑ � Q Standpipes(Spr�nkler Sys) J`b l�k� <br /> a Fire Alarm InstaUation Q Torch Rooflng(far Kettle � � j„l� `n�� <br /> � Fire Pumps � Weate Tire Stora Qe ANNUAL (� ���� l J(, � /� <br /> Fire Waks �1/ <br /> 7 �,� )/f' <br /> � Flammable Applica6on-A1rNUAL t�D� Valuation of Project v v <br /> Fuel T.anks <br /> Q Othef: <br /> Conhector ComPa�Y �`O T (G' •� <br /> Signature ` ReQiaterpd N Fee Cunern /N <br /> A�� Od License# � �j <br /> ELECTRICUI ----� <br /> Gompany <br /> Signpture Registered Y/N Fee Current Y/N <br /> Addresa <br /> Lfcense# . <br /> PLUMBER Company <br /> Signalure Registerad Y/N�Fee Currerrt Y/N <br /> Address Licensa# <br /> MECHANICAL � <br /> Company <br /> Signature Registered Y/N Fee Curront Y/N � <br /> Addfess <br /> License# <br /> OTHER �m�M � <br /> s�g�awre Reg�scered Y/N Fee c�ne�t Y/N <br /> Addrasc <br /> Licenae# <br /> Directions: <br /> Fill out epplication completely. <br /> Owner 8 Cor�tractor sipn beck of applicaUon,notarized{Or,copy of slgned contract wlth owrrer) <br /> if over$2500,a Notice of Commencement fs rsquired(Mechanicai work over 55000) <br /> Supply two(2J sets of drawings with applicable documentetion <br /> Allow 10.14 deys for rev(ew aftor submittal date. Parcel#-obtained from Property Tax{doUce(httpllappraiser.pescoqov.com) <br />