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13-14853
Zephyrhills
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2013
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13-14853
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Last modified
11/11/2014 1:11:32 PM
Creation date
11/11/2014 1:11:32 PM
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Building Department
Company Name
ELKS LODGE
Building Department - Doc Type
Permit
Permit #
13-14853
Building Department - Name
ELKS LODGE
Address
6851 WIRE RD
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8�3-780-002Q City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date�teceived `� Phone Contact for Permit (j3 �� � "7 <br /> Owner's Name � . � Owner's Phone Number � � � <br /> Owner's Address � <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> Job Address � Ga/)� Lot# � <br /> Sub Division Parcel# <br /> . . _ .. �„.. _ <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> aControlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> �rgency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum <br /> �` 2 <br /> Fire Alarm �0 ❑ � Sparklers /, �7 <br /> [,/g,� , <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installation /,1� <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Spnnkler Sys) ( <br /> � Fire Alarm Installation Q 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 /> Q Other: <br /> Contractor • , - Company Gtj,i..� p � �� <br /> Signature �, ^� Registered /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 /> 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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