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16-17365
Zephyrhills
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Building Department
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2016
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16-17365
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Last modified
11/1/2016 9:42:20 AM
Creation date
11/1/2016 9:42:20 AM
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Building Department
Company Name
HOUSING INDEPENDENCE INC
Building Department - Doc Type
Permit
Permit #
16-17365
Building Department - Name
HOUSING INDEPENDENCE INC
Address
5216 7TH ST HISTORIC
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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date ReceiYed ' Phone Contact for Permit �0.�� <br /> ����_'�.s. - - ------`.��--��..��.z, - �...z..�.�m. ...�_____ - — - <br /> Owner's Nam���� /�1 ,�� �tl� Owner's Phone Number � � � <br /> Owner's Addre� �o�-./� � ,�r� <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address � <br /> �:-�.�_......�,...�.,.a,..-��"'.,_�...-�... �"`.�"'_"'A.""'"'^._ .._,,....n.,.�.._...�..,,� ��_.�.__._.K "'-�.-....a,--�„ <br /> Job Address Lot# � <br /> Sub Division Parcel# <br /> �-,.:..-� ,�,.��_._... .,.�...._.,...�_.�,<.._..e.�.-._._.�_.�,.s._s._,w...,,�..._�---_ _---�-� -- - —:_�..__.__._._..�.�e.. -.v., - <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>30 kw LP/Natural Gas-ANNUAL Sale �i/��� <br /> � Fire Protection Maintenance-ANNUAL � Piaces of Assembly-ANNUAL d� � <br /> tr y emi �n t er <br /> Sprinkler � ❑ ❑ ❑ B � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <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 /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> �_�...,._� - - ..._._.._.�_..�... . - -------�-�_,r._.-:_�,.,.- - �, <br /> Contracto ✓ � Company <br /> Signatur� Registered Y/N Fee Current Y/N <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 /> e-=. .v_.._...__.:_,_;___e_.._..__.._.�._..V..�.__.._�_.�ti4�.:_,.<��...,....�..._.�_,a-..._K��___.�_,____..._...._.—�___.__._H......_.__-.:__v�_._s_..-_..__. ,a���_-----.:.�. <br /> Directions: <br /> Fill out application completely. <br /> Owner 8�Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> If over$2500,a Notice of Commencement is required(Mechanical work over$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 /> e <br />
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