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12-12900
Zephyrhills
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Building Department
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Permits
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2012
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12-12900
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Last modified
2/12/2013 11:33:31 AM
Creation date
2/12/2013 11:33:31 AM
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Building Department
Company Name
WELLESLEY DEVELOPMENT CORP
Building Department - Doc Type
Permit
Permit #
12-12900
Building Department - Name
WELLESLEY DEVELOPMENT CORP
Address
5538 GALL BLVD
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813-780-0020 Ciry of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Appiication <br />)ate Received �.j � Phone Contact for Permit � � Z- <br /> -- _ �...wz�rn:�r.».w::z...n=re_w. .- . g . ,-u..._ , R�� �.,w�a.a.�,.:�os,.,a.r�.:,� ... <br /> Nvner's Name / / /i� -� �—�""�� Owner's Phone Number �—� �� �� <br /> hroner's Address � C9 `' � � �'r / � <br />�ee Simple Titleholder Name Titleholder Phone Number � � <br />�ee Simple Titleholder Address <br />� ,, .�-,.x�.;.�;� :�.'� y<3��`�:�+€,��,c��. .�ra•n:,9w:�,�*, �'�:�a <br /> iob Address <br /> Lot# �� <br /> iub Division Parcel# <br /> .>- a �,�.,�.r.., x.r . _ ., .. � -- � :s:w**� ,-��t�::.-�s���x,�-�v�,�:arx �a _ �.. _ ;��v;d'�:�.�'�sst�ar�c� <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> �Comm Exhaust Kitchen Hood/Duct � 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 /> a Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Spartclers <br /> Hood Cleaning B'�� ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps a Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> , . . rv.��-�,�.�,��..��--xs �<,�� ��� ,-�� . =��� �,�;.�:�:�5„��� "�V <br /> Contractor � �r Company <br /> Signature �' R istered Y/N Fee Current Y/N <br /> Address °W �"� r �-av�C LJc 5�� G icense# <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 /> 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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