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813-780-0020 � ' �CI of Ze h fhIIIS FIf6 Fa -813-780-0021 <br /> ` ��� ��� Permit plication <br /> ' �� �� <br /> Date Received Phone Contact for Permit m� � <br /> ���-._._,�.-_--__...tl._a__.. - - � _.._.._�.�. __. -�.�.�._....�..........�__.__..�__.e.-.,..o_.....___..._.�.. � <br /> Owner's Name Q Owner's Phone Number � � <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address � <br /> �=--�'�___�u ------�K° - - - � <br /> Job Address Lot# �� <br /> Sub Division Parcel# <br /> ��,..��,..__........-...,.e.��....�.._..._._..._... _-^,-°.,--'s.�.,.m.._.�....--`�--.�.�,-.- - — ..,..._.�.,.. -- .�....�... . �,....�.......:.� _.,.:.�•-��°--°r <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>34 kw LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL <br /> tr y emi � t er <br /> Sprinkier � ❑ ❑ ❑ � � Recreational Bum � <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers �' S� <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations v ' � <br /> r <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � FlammableApplication-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> �:�:-.�n..�� - ._ ,�..v.........�,. ,_,�.��_,�.�...�.._.�. '�,�'_°"'_„"`' �� -"'� <br /> Contractor � � Company <br /> Signature e Registered Y/N Fee Current Y/N <br /> � <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> r�... �,�,�_.. ____��..�-.-N_..__.__-___.._„..M.�___...__N ,�,__....__ _ ��_._..,__e���.v...,:� ...r,__...o.__M,..,�._-.P.._.__..._�__�..._..._-_.._.,.._.__•.�__..�.,�__.:._.. <br /> Directions: <br /> Fill out application completely. <br /> Owner 8 Contractor sign back of application,notarized(Or,copy of signe contract with owner) <br /> If over$2500,a Notice of Commencement is required(Mechanical work o er$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(http://appraiser.pascogov.com) <br />