HomeMy WebLinkAbout11-11921 T CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020 11921
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 11921 Address: 38107 MARKET SQUARE DR
Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL.
Class of Work: FIRE-PROTECTION MAINTENAN E Township: Range: Book:
Proposed Use: MEDICAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number:
Improv. Cost:
Date Issued: 5/31/2011 Name: FLORIDA MEDICAL CLINIC
Total Fees: 25.00 Address: 38107 MARKET SQUARE
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 5/31/2011 Phone:
Work Desc: FPM-QUARTERLY FIRE SPRINKLER FOR FL MEDICAL CLINIC
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Chapter 633, Florida Statutes, authorizes the City to charge and coilect user fees to pay for the costs of fire
prevention and protection related activities such as inspections, plan review, administrative fees, and other
costs related to the aforementioned.
Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of
the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final
inspection shall be charged double permit fee per day of operation or a minimum of $100.00, whichever is greater. All
work shall be pertormed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE
OF COMMENCEMENT."
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P IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
3�3-780-OG20 ('.Iry Of z°pf1Y�r11IIS Fii v�• rax-o io-r ov-w� i
' P�rmit Appiication _ _.
D3t9 R°C eived �S • 3(' 20 �( - Phone Con,act ior Pertnit �a� Z( 3 7
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Own=r's Name � �L, GL //V ( C.. Owners Phons Number ��� C]
Owners Address $� 0 I �iT TtR'L �l 11� �� i�
res Simple TiUeholder Nams Titleholder Phons Number �� �
Fee SimpleTitleholdsrAddress
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JobAddress 0 S � Lot# ��
Sub Division Paroel #
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� Bio-Hazard Waste Storege-ANNUAL � FumigationTent
� Comm Exhaust Kitchen Hood/Duct � Hazardous Material ('fier II or RQ Faciliry) ANNUAL
� Controtied Bum a Hood InstallaGon
a Em=rgency Generator < 30 kw � LP/Natutal Gas-Installatio ,
� Emergency Generetor> 30 kw � LP/Natural Gas-ANNUA Sale �'(q �
� Fre Protection Maintenance - ANNUAL � Piaces of Assembly-AN L
t y emi Q ar -
Spnnkler � ❑ ❑ � Recreational Bum
�ire Alarm � ❑ ❑ ❑ � � Sparklers
Hood Cfeaning � O ❑ ❑� � Sprinkler System Instalfations
Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys)
� Fire Alarm ]nstallation � Torch RoofinglTar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
Fire Works
� Flammab(e Application- ANNUAL . �� Valuation of Project
Fuel Tanks
Q Other.
ConUactor ,���j/ '� ���j� Company
Signature ^� � Ragistered Y N Fee Current Y N
Address �'j�Q � • '�Q License � OO � � � �
ELECTRICIAN Company
Signature Registered Y/ N Fee Current Y/ N
Address License #
PLUMBER Company
Signature Registered Y/ N Fee Current Y/ N
Address License #
MECHANICAL Company
Signature Registered Y! N ree Current Y/ N
Address License #
OTHER Company
Signature Registered Y/ N Fee Current Y/ N
Address License r
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Directians:
Fill out application completely.
Owner & Contactor sign back of aoplication, no:arized (Or, copy of sign�d contrect with ownsr)
If ov=r 5250�, a Notice of Commen�>m=nt Is required (Mechanical work over 55000)
Supnly two (2) sets of drewings with appli:zb(e doeumentation
Allow �D-14 days for revi=w aft=r su5mi;tat date. Paro=1 r- obtained from Property Tax Notice (http://a���aiser.o=_scogov.co�n)