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11-12225
Zephyrhills
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Building Department
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Permits
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2011
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11-12225
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Last modified
5/14/2012 8:50:38 AM
Creation date
5/14/2012 8:45:40 AM
Metadata
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Template:
Building Department
Company Name
FLORIDA HOPSITAL OF ZEPHYRHILLS
Building Department - Doc Type
Permit
Permit #
11-12225
Building Department - Name
FLORIDA HOSPITAL OF ZEPHYRHILLS
Address
7050 GALL BLVD
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s�s-�so-oo2o City of Zephyrhills Fire Fax-813-780-0021 � <br /> Permit Application , n� �i� �i � <br /> (.��`,�_ <br /> '� Phone Contact for Permit �3 �.� D <br /> �ate Receiyed ,. - , .� ,P..4__, „ ,.- .. a.. < : �_�aK,. «-.,,.. . , r - <br /> �wner's Name � —' L��• ry { ' Owners Phone Number �� �� �� <br /> �wner'sAddress ���✓ 'A'LL '✓�v�' Zy 1 G'� �' "- ��5��.., <br /> =ee Simple Titleholder Name Titleholder Phone Number �� �� <br /> =ee Simple Titleholder Address <br /> . .. �,_.•.,. - �;.xi„�<„= • `�.R � � �r_-t�� _ �s,:a�.t^, .�..���!" . <br /> Job Address � � �� � S " ' ��vs Lot # �� <br /> 5ub Division Parcel # <br /> e . ,.:��,;�.� .x _ , � . . _ . �^^�.qaur+�;+a�. , , °• • -^�- 1 _, „ x�.k:: _ , . . , _ . . .. .;,g . a, <br /> � Bio-Hazard Waste Storage - ANNUAL a Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> a Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers �/�Z�s <br /> 7�! <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Fiammable Application- ANNUAL �Q SO� Valuation of Project <br /> � Fuel Tanks <br /> � Other: i. P2E> �GTlotv i2E`noUa�Yr� ` . <br /> t e:,.5�+t:�' ..,, ,e�k�K.4.,..:. r ,.. ,' *.s.�;,8a'a.tp[sE ra:R'F'"Y"'�f�',�e37.d'r��'''y'vq'.ryc�- , T��,'�5.r...�-"� . .'�;.,.<^...;'�.; . t is_.&".a!e5+���:c:-:°-. � .:.,.,^".a_ "*'«�'i�R`�;.:'?�s= <br /> Contractor Company � /Z v <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 /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> k <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://appreiser.pascogov.com) <br />
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