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11-12119
Zephyrhills
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Building Department
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Permits
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2011
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11-12119
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Last modified
5/10/2012 9:27:56 AM
Creation date
5/10/2012 9:27:56 AM
Metadata
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Building Department
Company Name
ZEPHYR HAVEN NURSING HOME
Building Department - Doc Type
Permit
Permit #
11-12119
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 �yEceived • � /� �/f Phone Contact for Permit � � �� Q �js <br /> Owner's Name �c: h (/�� u/� Owner's Phone Number $/'� �2 j'j'Q8 <br /> Owner's Address 3 �� /Q�/�' �L � � ,�$ f='L: 33S 2 <br /> Fee Simple Titleholder Name Titleholder Phone Number � C� �� <br /> Fee Simple Titleholder Address <br /> L�.� <br /> Job Address Lot # �� <br /> Sub Division Parcel # <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Faality) ANNUAL <br /> � Controlled Burn a 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 /> ❑ tr y emi � t er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Burn <br /> Fire Alarm � ❑ ❑ � � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ C� � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Warks <br /> � Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> � Other• <br /> Contractor , Company �Ar! •�j�' <br /> Signature Registered Y/ Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N Fee Current Y/ N <br /> Address • <br /> License # <br /> PLUMBER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> MECHANICAL <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> 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 (http:l/appraiser.pascogov.com) <br />
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