Get FL FDACS-03560 2012-2024

Florida Department of Agriculture and Consumer Services Division of Consumer Services WEIGHING AND MEASURING DEVICE PERMIT APPLICATION ADAM H. 66 F.S. and Rule 5F-5. 002 F.A. C. and I am empowered to execute this application on behalf of the above named entity or individual. PRINT/ TYPE NAME OF APPLICANT TITLE SIGNATURE DATE Org. Code 42 10 06 25 000 EO A2 Object Code 002301 PERMIT WORKSHEET ON PAGE 2 MUST BE COMPLETED AND SUBMITTED WITH APPLICATION. FDACS-03560 Rev. 12/12 Page 1 of 2 Permit Fee Worksheet Directions Insert the number of each device type and calculate fee. FreshFromFlorida.com - or Check or Money Order payable to FDACS and remit with form to FDACS P. O. Box 6700 Tallahassee FL 32314-6700 For DACS Use Only BUSINESS NAME STORE BUSINESS ADDRESS CITY STATE BUSINESS TYPE CHECK ONE CORPORATION LLC PARTNERSHIP LAW ENFORCEMENT AGENCY SOLE PROPRIETOR OTHER FEDERAL EMPLOYER ID FEID OWNER S NAME MAILING ADDRESS STATE ZIP BUSINESS PHONE EMAIL This application for permit applies only to the total number of specific device types listed on page 2. PUTNAM COMMISSIONER BUSINESS ID Chapter 531. 62 F*S* Rule 5F-5. 002 F*A. C. Remit Application Fee Online at www. I certify that this applicant is aware of and complies with all of the requirements of ss. 531. 60 - 531. DEVICE TYPE 1a RETAIL SCALES - 0 to 100 lbs. capacity FLAT RATE FEE 1 to 5 at location AMOUNT 40. 00 125. 00 2a SCALES Greater than 100 lb. up to including 250 lb. capacity NUMBER OF DEVICES FEE PER X 75. 00 ea 150. 00 ea 200. 00 ea 5 WHEEL LOAD WEIGHERS 6 RAILWAY TRACK SCALES 7 MULTIPLE DIMENSION MEASURING DEVICES 8 BELT CONVEYOR SCALES 9 MASS FLOW METERS Max flow rate or 150 lb per minute 11 VOLUMETRIC METERS Max flow rate or 20 gal per minute 80. 00 ea 13 TANKS USED AS MEASURES or to 500 gal capacity 15 GRAIN MOISTURE METERS 16 TAXIMETERS SUBTOTAL 17 LATE FEES- Fees due when payment is 30 days past due date 100. DEVICE TYPE 1a RETAIL SCALES - 0 to 100 lbs. capacity FLAT RATE FEE 1 to 5 at location AMOUNT 40. 00 125. 00 2a SCALES Greater than 100 lb. up to including 250 lb. capacity NUMBER OF DEVICES FEE PER X 75. 00 2a SCALES Greater than 100 lb. up to including 250 lb. capacity NUMBER OF DEVICES FEE PER X 75. 00 ea 150. 00 ea 200. 00 ea 5 WHEEL LOAD WEIGHERS 6 RAILWAY TRACK SCALES 7 MULTIPLE DIMENSION MEASURING DEVICES 8 BELT CONVEYOR SCALES 9 MASS FLOW METERS Max flow rate or 150 lb per minute 11 VOLUMETRIC METERS Max flow rate or 20 gal per minute 80. 00 ea 150. 00 ea 200. 00 ea 5 WHEEL LOAD WEIGHERS 6 RAILWAY TRACK SCALES 7 MULTIPLE DIMENSION MEASURING DEVICES 8 BELT CONVEYOR SCALES 9 MASS FLOW METERS Max flow rate or 150 lb per minute 11 VOLUMETRIC METERS Max flow rate or 20 gal per minute 80. 00 ea 13 TANKS USED AS MEASURES or to 500 gal capacity 15 GRAIN MOISTURE METERS 16 TAXIMETERS SUBTOTAL 17 LATE FEES- Fees due when payment is 30 days past due date 100. DEVICE TYPE 1a RETAIL SCALES - 0 to 100 lbs. capacity FLAT RATE FEE 1 to 5 at location AMOUNT 40. 00 125. 00 2a SCALES Greater than 100 lb. up to including 250 lb. capacity NUMBER OF DEVICES FEE PER X 75. 00 ea 150. 00 ea 200. 00 ea 5 WHEEL LOAD WEIGHERS 6 RAILWAY TRACK SCALES 7 MULTIPLE DIMENSION MEASURING DEVICES 8 BELT CONVEYOR SCALES 9 MASS FLOW METERS Max flow rate or 150 lb per minute 11 VOLUMETRIC METERS Max flow rate or 20 gal per minute 80. .