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11-11892
Zephyrhills
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2011
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11-11892
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Last modified
2/9/2012 1:26:49 PM
Creation date
2/9/2012 1:26:49 PM
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Building Department
Building Department - Doc Type
Permit
Permit #
11-11892
Building Department - Name
CLOCK FAMILY RESTAURANT
Address
5317 GALL BLVD
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s�saao-oozo Ciry of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received r � Phone Contact for Pertnit ��� � <br /> Owner's Name Z �lrG �/ �¢scl� Owners Phone Number ��� <br /> Owners Address �3 l 7 � � L. (/ ZP �/- � S � <br /> Fee Simple Titleholder Name Titleholder Phone Number C� �� <br /> Fee Simple Titleholder Address <br /> Job Address 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 /> � Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum <br /> Fire Alartn � ❑ ❑ ❑ � a Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ � ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alartn Installation � 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 /> � . � a. . . �. . ri�' . :w`X � � 5 • r4 �.... ..v . . ..�d ai'"- . . . ... . . . . <br /> Contractor Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature I 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 Company � �Q� � f �L� <br /> Signature Registered N Fee Current / N <br /> Address License # (�p p Q <br /> DirecGons: .. ._ .._ ..,_, -..,m. , _. .... ..,�. , �... .,, ,. .. �,. �m....� .gR.= , < � v. .. ., .. <br /> Fill out appiication 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:/lappraiser.pascogov.com) <br />
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