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- CITY OF ZEPHYRHILLS
5335-8l'H SIREET
(sis)�so-oozo � 13851
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 13851 Address: 38250 A AVE
Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL.
Class of Worlc: FIRE-PROTECTION MAINTENAN E Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 1426-21-0010-01300-0010
Improv. Cost:
Date Issued: 2/08/2013 Name: ZEPHYR HAVEN NURSING HOME
Total Fees: 25.00 Address: 38250 A AVE
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 2/08/2013 Phone: (407 975-3000
Work Desc: FPM- SPRINKLER ANNUAL-ZEPHYR HAVEN NURSING
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Chapter 633, Florida Statutes,authorizes the City to charge and collect user fees to pay far 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
a�s-�eo-oozo City ofZephyrhtlls Fire Fax-813-780-0021
.� Permit Application
Date Received 2/6/2013 Phone Contact for Permit 813 313 1611
Owner's Name Ze h r Haven Nursin Home Owner's Phone Number �� �
Owner's Address 38250 A AVE ZEPHYRHILL FL 33542-5759
Fee Simple Titleholder Name Titleholder Phone Number �� �
Fee Simple Titleholder Address
Job Address �
Lot#
Sub Drvision 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
❑ Emergency Generator<30 kw � LP/Natural Gas-Installation
� Emergency Generator>30 kw �
LPlNatural Gas-ANNUAL Sale
Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
Sprinkler ����� � Recreational Bum �{i/ ,3�/
Fire Alarm ❑ ❑ ❑ ❑ � � Sparklers � �
Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
Hood Suppression � � ❑ ❑ � � Standpipes(Sprinkler Sys)
� Fire Alarm Installation � Torch Roofing/Tar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
� Fire Works
� Flammable Application-ANNUAL r--� Valuation of Project
❑ Fuel Tanks
x❑ Other Backflow
Contractor Wanda Paradis Comp Sim lex Grinnell
Signature Regist Y/N Fee Cu Y/N
Address 4701 Oak Fair Blvd,Tam a FL 33610 License#
ELECTRICIAN Compan
Signature � Regist Y/N Fee Cw Y/N
Address
License#
PLUMBER
Compan
Signature Regist Y/N Fee Cu Y/N
Address
License#
MECHANICAL Company
Signature � Registd_Y/N Fee Cu Y 1 N
Address —
License#
OTHER Company
Signature Regist�_ Y/N Fee Cu 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 applicab�e documentation
Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)