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813-78U-UU20 c;iry or cepnymms rire rax-ts�3-iuu-uun <br /> Permit Application <br /> ate Received <br /> �,„o.���,,�,,,,,� ���������#�} Phone Contact for Permit <br /> - , ...� <br /> �wner's Name x /�L.L/�^lt:G ��(U�'C t1 �� ZcPI.��,Q���t�� p�,,�er's Phone Number � �� � <br /> �wner'sAddress "��i�.J`� f"O/'c'T' f�i,�.)� ,eD ��P�-�rRr����s, F'L - 3J�$�'�fa <br /> ee Simple Titleholder Name Titleholder Phone Number � C� �� <br /> ee Simple Titleholder Address <br /> � <br /> �b Address Lot# C� <br /> ub Division Parcel# <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ F�acility)ANNUAL <br /> � Controiled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> aEmergency Generator>30 kw a LPMatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANN� � � � Places of Assembly-ANNUAL I "%'��l(� <br /> y emi n er /� � ( `E� <br /> ❑ � ❑ ' <br /> Sprinkler ❑ p ❑ Recreational Bum '� <br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ C� � Sprinkler System Installations <br /> Hood Suppression � p ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> QFire Alarm Installation � To�h Roofing/Tar Kettie <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL <br /> � �-� Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> Antractor � <br /> ignature u � ' , Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> LECTRICIAN <br /> Company <br /> ignature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br />'LUMBER <br /> Company <br />�ignature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br />�ECHANICAL <br /> Company <br />;ignature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br />)THER <br /> Company <br />�ignature Registered Y/N Fee Current Y/N <br /> Address <br /> �-- � License# <br /> iirections: " 3",Y`a-�-� z - <br /> �;�,��,�: <br /> Fill out application completely. <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed coniract with owner) <br /> If over$2500,a Notice of Commencement is required(Mechanical work over$5000) <br /> Supply two(2)sets of drawings with appiicable 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 />