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11-12000
Zephyrhills
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Building Department
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Permits
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2011
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11-12000
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Last modified
3/30/2012 11:37:42 AM
Creation date
3/30/2012 11:37:42 AM
Metadata
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Template:
Building Department
Company Name
ADVENTIST HEALTH SYSTEM
Building Department - Doc Type
Permit
Permit #
11-12000
Building Department - Name
ADVENTIS HEALTH SYSTEM
Address
7350 DAIRY RD
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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> - . .. - <br /> Date Received ZLS /� Pho o t gSf � {P S� /.� S x <br /> ne C ntact for Permi V <br /> . •',�°'. ' u`i?3A.-�.c::t'°�,ib.A;. „ . b .. .. r �c�as'ita:. �'.:�Ei4;x . -:s�.sk .t:;::i ",.3`:': ,Y-.:�E:, : .'S:' .,. ._. .. .<x4`:.*�a.. � °u�sa:'x�s*sb n..s ° �'N,a.. � .:,, c�ew_� .., . <br /> Owner's Name �L � y Lj �� d' C�A Owner's Phone Number �I 3 7 gp �� <br /> Owners Address `73Sf1 �A%Ie /� �� R �L% «'/� / �-` 3� sy� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> ;'.'' :�t:,. ' i�:�.'. • �` 4��;�� :�'t%:.";�€�:" 1"�:6�,�"� M •l:'z° �'�:5�` �:'�.a"��.��i�� � ��1 '�°'�<,.°.".' .� ., �a'?.g�i3�.'. "�;�'� <br /> Job Address Lot # � <br /> Sub Division Parcel # <br /> 8�":�i" s..9.•L oi .«..> m„I3l.%i"Y',L$, ,S: i'A�..`:.'7r.`'d�ra' '.���%ta.:.a ,L° z$.�.":A'n`'e..:.;.:., .;.. >. . S.� .:. '.r.. R$�� 'w�.:. '�' .A�.<�'`��� ''?tia�P'�fiat� . S" <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material (Tier II or RQ Faciiity) ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Instailation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale / ��/, <br /> � Fire Protection Maintenance - ANNUAL Places of Assembly-ANNUAL �{/ V <br /> tr y emi �n t er � <br /> Sprinkler � �► ❑ ❑ B � Recreational Burn <br /> Fire Alarm � ❑ O ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � D ❑ ❑� � Standpipes (Sprinkler Sys) <br /> � Fire Alarm 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 /> � Other <br /> , .. rv. �. „. ._,� ; t�� �„�. - . . ;��-�.., ,� .,� .. ..,. ... .aW . �..�.�x .., o. ..�... :���.. . .. ..;:�m,M .�,.w <br /> Contractor ' Company j�t L� %I/1G <br /> Signature Registered Y/ 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 /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTkiER Company <br /> Signature Registered Y/ N Fee Current 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 �ftgr submittal date. Parcel #- obtained from Property Tax Notice (http.//appraiser.pascogov com) <br />
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