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. 10 l(fq 813- 780 -0020 City of Zephyrhills Fire i Fax- 813 -780 -0021 Permit Application Date Received ( I Phone Contact for Perm it 1813 11630 1 10303 I Owner's Name I Zephyr Commons, LLC I Owner's Phone N umber I Owner's Address 1 3629 Madaca Ln. Tampa FL 33618 Fee Simple Titleholder Name Titleholder Phone N umber Fee Simple Titleholder Address Job Address Lot # Staples 1889 - 7910 Gall Blvd 14 Sub Division Zephyr Commons Phase 1 Parcel # 1 35.25.21.0130.00000.0140 n Bio-Hazard Waste S torage - ANNUAL n Fumigation Tent Comm Exhaust Kitchen Hood /D uct n Hazardous Material (Tier II or RQ Facility) ANNUAL El Controlled Burn n Hood Installation E Emergency Generator < 30 kw n LP /Natural Gas - Install ation Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale © Fire Protection M aintenance - ANNUAL n Places of Assembly-ANNUAL © ry 'Semi' Oa Other Sprinkler ❑ ❑ )9 n Recreational Burn Fire Alarm El ❑ ❑ ❑ I ( n Sparklers Hood Cleaning n ❑ ❑ ❑ I 1 n Sprinkler System Installations Hood Suppression E ❑ ❑ ❑ I 1 [ Standpipes (Sprinkler Sys) n Fire Alarm Installation n Torch Roofing/Tar Kettle Fire Pumps n Waste Tire Storage ANNUAL El Fire Works n Flammable Appl ication- ANNUAL 1150 I Valuation of Project n Fuel Tanks n Other: I Contractor Company Wayne Automatic Fire Sprinklers, Inc. I Signature / Registered X / N I Fee Current 1 X/ N I Address 13226 Cherry Palm Drive, Tampa FL 33619 I License # I DIM ((..0 ono 1 A Oc rb I ELECTRICIAN Company Signature Registered Y / N I Fee Current I Y/ N I Address I License # I PLUMBER Company Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # I MECHANICAL Company Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # OTHER Company I Signature Registered Y/ N J Fee Current I Y/ N I Address I I License # Directions: Fill out appiic ation ccmplctely. Owner & Contractor sign back o f application, notarized (Or, copy of signed contract with ow ner) If over $2500, a Notice of C ommencement 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 )