HomeMy WebLinkAbout12-12750 _ CITY OF ZEPHYRHILLS f-�
5335-8TH STREET
(si3)�8o-oozo 12750
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 12750 Address: 38233 DAUGHTERY RD
Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL.
Class of Work: FIRE-PROTECTION MAINTENAN E Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 35-25-21-0010-12300-0000
Improv. Cost:
Date Issued: 2/01/2012 Name: ADVENTIST HEALTH SYSTEM
Total Fees: 25.00 Address: 7050 GALL BLVD
Amount Paid: 25.00 ZEPHYRHILL FL 33541
Date Paid: 2/01/2012 Phone: (813)783-6189
Work Desc: FPM- SPRINKLER QUARTERLY-ADVENTIST HEALTH
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Chapter 633, Florida Statutes,authorizes the City to charge and collect user fees to pay for the oosts 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 perFormed 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 AITORNEY 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
813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
, Permit Application
Date k'eceived 1/30/2012 Phone Contactfor Permit 813 313 1637
Owner's Name FL Hospital Zephyrhills-Ctr Wound Care& Hyperbar Owner's Phone Number C 813 783 6106
owner's Address 7050 Gall Bivd,Zephyrhills FL. 33541
Fee Simple Titleholder Name Titleholder Phone Number C� � �
Fee Simple Titleholder Address L—
Job Address 38233 DAUGHTERY RD ZEPHYRHILLS FL 33540 � ��
Lot#
Sub Division
Parcel#
� Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
� Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
� Controlled Burn � Hood Installation
aEmergency Generator<30 kw � LP/Natural Gas-Installation
� Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
� Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL �
� tr y emi �n t er ❑ � ^j�
Sprinkler X ❑ ❑ Recreational Burn !
Fire Alarm � ❑ ❑ ❑ � � Sparklers
Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
� Fire Alarm Installation � Torch Roofingffar Kettle
a Fire Pumps � Waste Tire Storage ANNUAL
� Fire Works
� Flammable Application-ANNUAL
� Valuation of Project
Fuel Tanks
0 Other�
Contractor
comPany SimplexGrinnell
Signature Registered Y/N Fee Current Y/N
Address 4701 Oak Fair Blvd., Tampa, FL. 33610 License#
ELECTRICIAN
Signature
Company
Registered Y/N Fee t:urrent Y/N
Address
License#
PLUMBER
Signature
Company
Registered Y/N Fee C;urrent Y/N
Address
License#
MECHANICAL
Signature
Company
Registered Y/N Fee Current Y/N
Address
License#
OTHER
Signature
Company
Registered Y/N Fee Current Y/N
Address
License#
Directions:
Fill out application completely
Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner)
If over$2500,a Notice of Commencement is required(Mechanical work over$5000)
Supply two(2)sets of drawings with applicable documentation
Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov com)