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09-9724
Zephyrhills
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2009
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09-9724
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Last modified
1/10/2011 10:28:56 AM
Creation date
1/10/2011 10:28:55 AM
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Building Department
Company Name
WELLSPRINGS
Building Department - Doc Type
Permit
Permit #
09-9724
Building Department - Name
WELLSPRINGS
Address
37815 15TH AVE
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813780 -0020 City ofZephyrhills Fire Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit ( ( 1 <br /> Owners Name Z e 3�4 9ep#4' Owners Phone Number ) ���3 1 <br /> Owners Address 37jy5 /Si' 41,,. Ltd <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address 378 '/5 /511 1 ) Lot# <br /> Sub Division Parcel # <br /> f Bio- Hazard Waste Storage - ANNUAL I ( Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum n Hood Installation <br /> Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> �Utrly JSemll I" Fi I Uther <br /> Sprinkler ❑ I Recreational Bum <br /> Fire Alarm ❑ ❑ pa 1 I I I Sparklers <br /> Hood Cleaning ❑ ❑ ❑ 1 n Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ l I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I ( Valuation of Project <br /> Fuel Tanks <br /> El Other <br /> Contractor Company <br /> Signature Registered Y / N _ Fee Current ( Y / N <br /> Address l I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N .J Fee Current I Y/ N 1 <br /> Address I License # <br /> PLUMBER Company <br /> Signature Registered Y / N _ Fee Current I Y / N <br /> Address l t <br /> License # ! <br /> MECHANICAL Company <br /> Signature Registered Y/ N j Fee Current I Y/ N j <br /> Address I License # <br /> OTHER /� � � Company <br /> Signature Registered Y / N j Fee Current Y / N , <br /> Address License # <br /> Directions: <br /> Fill out application completely. <br /> Owner & 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 Notce (http: / /appraiser.pascogov.com) <br />
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