HomeMy WebLinkAbout12-13030 CITY OF ZEPHYRHILLS
5335-8TH STREET
(si3)�so-oozo 13030
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 13030 Address: 38051 MARKET SQUARE DR
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 Nurr�ber: 02-26-21-0010-03900-0020
Improv. Cost:
Date Issued: 5/03/2012 Name: FMC MARKET SQUARE INC
Total Fees: 25.00 Address: 38135 MARKET SQUARE
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 5/03/2012 Phone:
Work Desc: FPM-QUARTERLY FIRE SPRINKLER FOR FLORIDA MEDICAL CLINIC (38051)
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Chapter 633, Florida Statutes,authorizes the City to charge and collect 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 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 ATTORNEY BEFORE RECO IN Y R NOTICE
OF COMMENCEMENT." `
PERMIT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041
s�3-�so-oo2o City of Zephyrhilis Fire Fax-813-780-0021
� . Permit Application
Date Received ` � '` Phone Contact for Permit $�3 621 1357
Owner's Name FLORIDA MEDICAL CLINIC Owner's Phone Number � � �
owner's Address 38135 MARKET SQUARE DR., ZEPHYRHILLS, FL 33542
Fee Simple Titleholder Name Titleholder Phone Number � � �
Fee Simple Titleholder Address
JobAddress 38051 MARKET SQUARE DR., ZEPHYRHILLS, FL �ot# �
Sub Division CITY OF ZEPHYRHILLS Parce�# 02-26-21-0010-03900-0020
� Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
a Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ F�acility)ANNUAL
aControlled Burn � Hood Installation
� Emergency Generator<30 kw � LP/Natural Gas-Installation
� Emergency Generator>30 kw � LP/Natural Gas-ANNUAL fS'ale/! �U� �)
� Fire Protection Maintenance-ANNUAL � Places of Assembiy-AI�IUAL � ,/�
r y em� �n er �.r�''�
Sprinkler � � ❑ ❑ � � Recreational Burn `'p`;r
Fire Alarm � ❑ ❑ ❑ � � Sparklers 'i� � �� � � - �
� �
Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) �
� Fire Alarm Installation a Torch Roofing/Tar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
� Fire Works
� Fiammable Application-ANNUAL $25.�Q Valuation of Project
aFuel Tanks
Q Other�
Contractor Company
Signature Registered Y/N Fee Current Y/N
Address License#
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 Fee Current Y/N
Address License#
OTHER JEFFERY D. BURNHAM Company RODAN FIRE SPRINKLERS, INC.
Signature �/`�" Registered Y/N Fee Current Y/N
Address 1 7 T T A F 1 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)