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a�s-�ao-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Re tP'vetl Phone Contact for Permit 813 621 1357 <br /> Owner's Name FLORIDA MEDICAL CLINIC Owner's Phone Number �� C� C� <br /> owner's Address 38107 MARKET SQUARE DR , ZEPHYRHILLS, FL 33542 <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� �� <br /> Fee Simple Titleholder Address <br /> L.� <br /> JobAddress 38107 MARKET SQUARE DR., ZEPHYRHILLS, FL 33542 � <br /> Lot # <br /> Sub �ivision CITY OF ZEPHYRHILLS Parce� # <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Burn � Hood Instailation <br /> � Emergency Generator < 30 kw � LP/Naturai Gas-Installation <br /> � Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> � r y emi � er ❑ <br /> Sprinkler � ❑ ❑ Recreational Burn <br /> Fire Alarm � ❑ p ❑ C� � Sparklers <br /> Hood Cleaning � ❑ ❑ O C� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ �� � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofinglfar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL $25.QQ Valuation of Project <br /> � Fuel Tanks <br /> Q Other� <br /> Contractor ' ' <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y! N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> MECHANICAI <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> OTHER <br /> Signature <br /> JERRY T. BARROW Company R AN FIRE SPRINKLE , INC. <br /> tered N Fee Current N <br /> Address 2 � T T A P License # q 4 2 � <br /> Directions: <br /> Fill out application completely <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicabie documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />