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10-10271
Zephyrhills
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2010
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10-10271
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Last modified
1/27/2011 3:28:39 PM
Creation date
1/27/2011 3:28:38 PM
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Building Department
Company Name
WESTBROOK MANOR
Building Department - Doc Type
Permit
Permit #
10-10271
Building Department - Name
ALLEGIANCE SENIOR CARE
Address
6701 DAIRY RD
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0020 City of Zephyrhills Fire. Fax- 813 -780 -0021 <br /> Permit Application <br /> Phone Contact for Permit 11'( 094 it <br /> mossommenewitommumbh:, ..—_. <br /> Owner's Name [W'f4 ,tbr ll. 44.444zr ( Owner's Phone Number <br /> ,per's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number I I I <br /> Fee Simple Titleholder Address I n r p(� / / <br /> Job Address.,, G?0 ,. DA i 2S 1/RL+1'U P Lot# I <br /> Sub Division I I Parcel # I <br /> n Bio -Hazard Waste Storage ANNUAL I—I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> E l Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas- ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> ((Amyl IsemI inn 'other 1 1 Sprinkler n ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm I - A- ❑ ❑ tik ( 1 1 1 Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 1 1 Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ 1 I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> I Flammable Application- ANNUAL 1 Valuation of Project <br /> I Fuel Tanks <br /> Other: <br /> Contractor l Company j j . v 1� <br /> Signature �r -.4a C /� Registered %' Fee Current r� <br /> t <br /> Address I n11 1 w , 1.4/k Sl-5 - r I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address I I License # I • I <br /> MECHANICAL Company . <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 I License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 1 License # I I <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> tf 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 />
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