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11-12223
Zephyrhills
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2011
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11-12223
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Last modified
5/14/2012 8:44:27 AM
Creation date
5/14/2012 8:44:26 AM
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Building Department
Company Name
COMMUNITY CHAPEL COG
Building Department - Doc Type
Permit
Permit #
11-12223
Building Department - Name
COMMUNITY CHAPEL COG
Address
5320 1ST ST
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s��-�so-oo2o Ciry of Zephyrhilis Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received � � Phone Contact for Pertnit �� �' C"� <br /> Owner's Name Ownets Phone Number �� ��� <br /> Owner's Address <br /> Fee Simple Titleholder Name TiUehofder Phone Number �� ��� <br /> Fee Simple Titleholder Address , „ <br /> . ;,,.er- °9`>r .:�;�•..� a .e. ; . ;�,... .�,�. ea .. _ . a:s°ra �,,wgp.�:.-�.;,.�:r..�. t. <br /> y ° . + � <br /> Lot # <br /> Job Address <br /> Sub Division Parcel # <br /> . r v 3� . . . : M . �. + <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen HoodlDuct a 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 /> �r emi �n er � <br /> Sprinkler � ❑ ❑ ❑ Recreational Bum <br /> Fire Alartn � ❑ ❑ ❑ Sparklers <br /> Hood Cleaning ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ��� � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofinglfar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL � Valuation of Project <br /> � Fuel Tanks <br /> Q Other. , . A , . <br /> Contractor Company <br /> Signature Registered Y/ N Fee Curtent Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature I <br /> Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature <br /> 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 <br /> Signature Registered Y/ M Fee Current Y/ N <br /> Address License # <br /> D irections: �*. ~f, M. � u � , M,4 », � <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://appraiser.pascogov.com) <br />
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