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11-11882
Zephyrhills
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2011
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11-11882
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Last modified
2/9/2012 1:21:10 PM
Creation date
2/9/2012 1:21:09 PM
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Building Department
Building Department - Doc Type
Permit
Permit #
11-11882
Building Department - Name
WELLESLEY DEVELOPMENT CORP
Address
5538 GALL BLVD
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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received / �� Phone Contact for Permit ��� � <br /> Owners Name � f � � �� �_�^� Owners Phone Number C� C� �� <br /> Owner's Address <br /> Fee Simple Titleholder Name � Titleholder Phone Number � C� C� <br /> Fee Simple Titleholder Address <br /> Job Address J��(� �j "— ! � /� � v �"7 f /� / Lot # �� <br /> Sub Division Paroel # <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 /> a Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> ❑ � emi � er ❑ <br /> Sprinkler O ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ � � Sparklers 1 (/� <br /> Hood Cleaning � � ❑ � � � ` ` <br /> Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ �� � Standpipes (Sprinkler Sys) <br /> � Fire Alartn I�stallation � 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 /> Contractor _ � <br /> Company <br /> Signature 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 /> MECHANICA Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <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 />
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