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10-11090
Zephyrhills
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2010
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10-11090
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Last modified
8/16/2011 8:31:39 AM
Creation date
8/16/2011 8:31:38 AM
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Building Department
Company Name
ZEPHYR HAVEN NURSING HOME
Building Department - Doc Type
Permit
Permit #
10-11090
Building Department - Name
ZEPHYR HAVEN NURSING HOME
Address
38250 A AVE
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813:780 -0020 'City of.Zephyrhills-Fire Fax - 813-780 -0021 <br /> 'Permit Application <br /> Date Received 6. 7' 'O Phone Contact 2 / Permit <br /> tact for �j 3 76 6644 <br /> Owner's Name oZi 7 r c ry Owner's Phone Number <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Address I <br /> Job Address 3s 4 Lot # <br /> Sub Division Parcel # <br /> Bio- Hazard Waste Storage- ANNUAL n Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> • n 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 -ANNU • <br /> rat7I <br /> Semi (J Other 1 <br /> Sprinkler ❑ ❑ ❑ I I Recreational Bum �( / / 0 (J <br /> Fire Alarrn E ❑ ❑ ❑ I I I Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I I n . Sprinkler System Ins - Nation - <br /> Hood Suppression Z ❑ ❑ I I E Standpipes (Sprinkler s) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> I Fire Works <br /> El Flammable Application- ANNUAL Valuation of Project <br /> I - 1 Fuel Tanks <br /> Other. I <br /> Contractor Company <br /> Signature _... Registered N ee Current I Y / N <br /> Address I /17C)( reek cub- , 1 � ? lud '7`C, t.34 3s4, to ( License # 1 CD C% 1 <br /> ELECTRICIAN Company <br /> Signature I Registered Y / N J Fee Current Y / N j <br /> Address I I License #. <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y / N - <br /> Address I I License # I <br /> MECHANICAL . Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current I 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 Notice ( littp: / /appraiser.pascogov.com) <br />
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