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11-12500
Zephyrhills
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2011
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11-12500
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Last modified
6/18/2012 2:45:08 PM
Creation date
6/18/2012 2:45:08 PM
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Building Department
Company Name
ADVENSTIST HEALTH SYSTEM
Building Department - Doc Type
Permit
Permit #
11-12500
Building Department - Name
ADVENTIST HEALTH SYSTEM
Address
38233 DAUGHTERY RD
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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> , � Permit Application <br /> Date Received / Z(/�'/ Phone Contact for Permit ��{� s� d 73S <br /> Owner's Name /"�,Lsi(/�iQ j i�T4G z� �+ �"� j C�,�' Owner's Phone Number �� � <br /> Owner's Address � � � 3� �/�-!t '� � �O� �� � � � `� t- i1 <br /> J..! V <br /> Fee Simple Titleholder Name Titleholder Phone Number ��� C� <br /> Fee Simple Titleholder Address <br /> Job Address Lot # � <br /> Sub Division Parcel # <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> a 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-Instatlation <br /> � Emergency Generator> 30 kw � LP1Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places ofi Assembly-ANNUAL <br /> ry emi � er <br /> Sprinkler � ❑ ❑� � Recreational Burn 2 S�(� <br /> Fire Alarm � ❑ ❑ ❑ � <br /> � ❑ Sparklers <br /> Hood Cteaning � ❑ ❑ ❑ � Sprinkler System Instailations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Spnnkler 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 /> Contractor � <br /> - Company ji°►t ���f/ij� <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 <br /> License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER <br /> 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 after submittal date Parcel #- obtained from Property Tax Notice (http //appraiser.pascogov com) <br />
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