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09-9304
Zephyrhills
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Building Department
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Permits
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2009
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09-9304
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Last modified
1/20/2011 12:53:39 PM
Creation date
1/20/2011 12:53:38 PM
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Building Department
Company Name
WESTBROOKE MANOR
Building Department - Doc Type
Permit
Permit #
09-9304
Building Department - Name
ALLEGIANCE SENIOR CARE
Address
6701 DAIRY RD
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813-780-0020 City of.Zephyrhiilsl try fq Fax -813- 780 -0021 #r <br /> Permit Application <br /> Date Received 1 1 - Prone Con act for Permit i mplow ( 1 I 1 lo Owner's Name I e 1pfOO V\ 4‘ 1 Owner's Phone I r 1 I 1 T 2 I E <br /> owner's Address I loo \ �- a tl-'c W 7 Vevi \ kk ,' L I <br /> Fee Simple Titleholder Name I 1 Titleholder Phone Number 1 1 1 I <br /> Fee Simple Titleholder Address 1 <br /> Job Address I 1 Lot# 1 1 <br /> Sub Division I I Parcel # 1 I <br /> ❑ Bio -Hazard Waste Storage - .ANIMAL n Fumigation Tent <br /> ❑ Comm Exhaust Kitchen HoodlDuct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> ❑ Controlled Bum . Hood Installation <br /> n Emergency Generator < 30 kw n LP/Nahxal Gas - installation <br /> El Emergency Generator> 30 kw n LP/Natural Gas - ANNUAL Sale <br /> ❑ Fire Protection Maintenance - ANNUAL ❑ Places of Assembly- ANNUAL <br /> Sprinider ❑ 0 0 ❑ n Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ ❑ 1 ( ❑ Spam <br /> Hood Clearing N l7 �"' 0 1 1 r n S i m <br /> Hood Suppression 0 0 0 1 ( r Standpipes (Sprinkler Sys) <br /> ❑ Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps ❑ Waste Tue Storage ANNUAL <br /> Fue Works <br /> Flamm Application- ANNUAL 1 I Valuation of Project <br /> Fuel Tai*s <br /> IIIII •e -r. I <br /> . ........... CornixarlY <br /> Signature IMF A - '' � � + A Registered Y / N ! Fee Current ! Y / N I <br /> Address e.. _ - a c A e, 1 License # <br /> ELECTRICIAN! Company <br /> Signature I Registered Y / N I Fee Current I Y/ N, <br /> Address ( 1 License # 1 I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I YIN I <br /> Address' 1 License # ( 1 <br /> MECHANICAL Company ' <br /> Signature Registered Y/ N 1 Fee Conant , Y/ N 1 <br /> Address <br /> OTHER r <br /> Signature — Y/ N 1 Fee Current 1 Y/ N 1 <br /> Address + Svo d O $L Q / 25 i <br /> Directions: <br /> n _ <br /> Fill out application completely. 4,... CC 4 arP OLt' <br /> Owner & Contractor sign back of . <br /> if over $2500. a Notice of Comrne <br /> Supply two (2) sets of drawings a """----' <br /> Allow 10-14 days for review after, ; ,_a _ , i- '' ax Notice (httpJ/appraiser pasaogov.com) <br />
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