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CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 13465
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 13465 Address: 38220 HENRY DR
Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL.
Class of Work: FIRE-PROTECTION MAINTENAN E Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 02-26-21-0080-OOA00-0122
Improv. Cost:
Date Issued: 9/18/2012 Name: HCRA PROPERTIES I LLC
Total Fees: 25.00 Address: 333 N SUMMIT ST
Amount Paid: 25.00 TOLEDO OH 43604
Date Paid: 9/18/2012 Phone: (813)788-7114
Work Desc: FPM-SEMI FIRE ALARM FOR HEARTLAND HCR MANOR CARE
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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
813.780-0020 Gty of Zephyrhi(Is Fire Far-813-780-002'
Permit Application
Date Received � ' �
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Fee S�mple Titieholder Name Trtleholder Phone Number �� � �
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� Bio-Hazard Waste Storage-ANNUAL � Hazardous Material{Tier II w RQ FaciJity)ANNUAL
� Comr*Exhaust Kitchen Hood/Duct � Hood InstailaUOn
� Conuolled Bum , a LP/Netural Gas-Installation
� Emergency�enerator<30 kw � LP/Natural GasANNUAL Sale •
� Emergency Generator>30 kw � Places of Assembly-ANNUAL
aPire Protection Maintenance•ANNUAL a Recreatlonal Bum
�� em� �ril� er ❑ � c) ;
Sprinkler ❑ Q ❑ Sparklers /,� �
Fire Alarm � ❑ � O � � Sprinkler System InstaAations � l
Hood Cleaning � ❑ p ❑ � � Standpipes(Sprinkier Sys)
Hooc Suppression � O ❑ ❑ � � Torch Roofing/Tar Kettle
� Fire Alarrn Instaliation Q iMaste Tire Storage ANNUAI
� Fire Pumps
Fire Works
� Flammable Application-ANNUAL �� Valuation of Project
� Fuel Tanks
�] Other:
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Signature ���y T� y �u�'1'O
Re9�sterod Y/N Fee Cunent Y/N
Address 35 31 1�¢ 3},�rtG Rd. License# �F'000��l�!1
GLECTRICIAN � Company
Signature
Registered Y/N Fee Current Y/N
Atldress
Lic:ense#
NLUMBER � �mpany
Signature � Registered Y/N Fee Curcent Y/N
Adtlress
ucense# "'—�
MECHANICAL
S�gnature
Company
Registered Y./N Fee Curcent Y/N
Address ��# �_,_„�_�
OTHER
Signature
Company
Registered Y/N Fee Current Y/N
Address _
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F�II out appiiCation completefy . - -
Owner 8 Contractor sign badc of appiication,notarized(Or,cepy of signed contract with ownerj
ff over 52500,a Notice of Commenoement is required(MechaniCal work pver g5000)
SuPP�Y two(2)sets oi drawingS with aAWieable dxumentatlon
Atlow 10-14 days for review after submitta!date. Parcei#-obtained from Properiy Tax Notice(http://appraiser.pascogov com)