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$��-7$o-ao2fl Gity of Ze hyrhilis Fire Fax-813-780-0021
<br /> Permit pplication
<br /> Dafe t2eceived v ��� ����-{ Phane Contact for Permlt�C�_��� ��
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<br /> Owner's Name � �� J 04mer's Phone hlumbec � � t t� �_t�
<br /> Owner's Address C � � / J�
<br /> Fee Simple Titleholder Name Titleholder Phone Number �� � ��
<br /> Fee 8imple Titleholder Address
<br /> !�n,��.,.,�...�.....�.. ' _ _ _ -�- 9....,_�..._ �._.:.a
<br /> Jab Address � � � �LY�A �x��__�
<br /> �ot#
<br /> Sub Division Parcel#
<br /> �",.._.,�".::�-,:�:�.�-'_:°�..~�.�-- �....�.,..��.-._.,. ....M.r1.-_.^.....,__�..�7.. .e,.o._...�-��..__....._...�.,.�,.�._.�-'-"'-'..---:,:.��':��._�_ a_,.�.-._....,.....�_�._...�.,_._._a_.�-d�a
<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tenk
<br /> � Comm Fachaust Kitchen HoodlDuc# � Hazardous Material{Tier II ar RQ Faciiity}APINUAI
<br /> � Controlled Bum � Hood Installation �
<br /> oEmergency Genera#or<30 kw � lPlNatura}Gas-2nsfallation ('�
<br /> � v
<br /> Emergency Generator>30 kw LP/Na#ural Gas-ANNUAL Sale /��
<br /> 0 ��'�
<br /> Fire Protec#ion Maintenance-ANNUA! Places of Assembly-ANIYUAL
<br /> t y emi �n er
<br /> Sprinkier � ❑ ❑ O � Recreationai Bum
<br /> Fire Alarm � ❑ ❑ ❑ � Sparklers - ��Z�
<br /> Haod C{eaning � � O ❑ � Sprinkler System tnstallations �
<br /> Hood Suppressian � ❑ ❑ ❑ � Standpipes(Sprinkler Sys) '���1
<br /> Q Fire Alarm Installatian � Torch Roofingtt'ar Kettle
<br /> �/' f
<br /> � Fire Pumps � Waste Tire Starage ANNUAL
<br /> � Fire Works
<br /> � FlammableApplication-ANNUAL �_��� Valuatian of Project
<br /> � Fuel Tanks ,
<br /> Q Other:
<br /> 4'-e'J��,.K�,-a..w..`..�-......,+� «....w. .o-..:.�,w..,.-..m.�-n.o..v,..Va�n-._w�....a..,... ..w...-_..:.n�......,.�.�m�...�ev..�+o..m�.....:�.,.�w.=-.�..�•x..a�aw..._..��—�-.«....,. ��.."��.Se,�..,�-.��..»°`.d�-T,-...�M.�
<br /> Contractor �! ''' �-- Company
<br /> Signature ...�""""'— Regisiered Y/N Fee Current Y!N
<br /> Address License#
<br /> ELECTRtGIA11 Company
<br /> Signature Registered Y/N Fee Curcent Y/N
<br /> Address License#
<br /> PLUMBER Company
<br /> Signatute Registered Y/IV Fee Current Y 1 N
<br /> Address License#
<br /> MECHANICA! Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> OTHER Company
<br /> Signature Ragistered Y t N Fee Current Y 1 N
<br /> Address License#
<br /> ��.�., .:._�.�_......._.a.A.___�..__.....�,._.��.._....-,___....�...:�___...�•--y__..M._...._..�,.ti... r.A,._.__.____...._Y_�,�..._..�-�.�..�._..___��..�..,-,..�..__�,�.,��..,_..��.�....<..__..m.v __��°�.a_1
<br /> Directions:
<br /> Fill out epplication completely
<br /> Qwner&Contractar sign back af apglication,rsotarized{Or,copy of si ned contract wittr owner}
<br /> if over$2500,a Notice of Commencement is required(Mechanical w rk over$500q)
<br /> Supply two(2)sets of drawings with applicable dooumentatian
<br /> A1Iow 14-19 days for review aRer submittal date. Parc I#-obtained from Propesty Tax Notiee{http:tlappraiser.pascogov.com}
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