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ais-�ao-oo2o City of Zephyrhills Fire <br /> Fax-813-780-0021 <br /> - Permit Application <br /> Date Received r <br /> •--.—.—.,. Phone Contact for Permit 813 621 1357 <br /> owners Name FLORIDA MEDICAL CLINIC �� �� �� <br /> Owner's Phone Number <br /> owner'sAddress 38135 MARKET SQUARE DR., ZEPHYRHILLS, FL 33542 <br /> Fee Simple Titleholder Name (�� � �� <br /> Titleholder Phone Number L �� <br /> Fee Simple Titleholder Address <br /> JobAddress 38051 MARKET SQUARE DR., ZEPHYRHILLS, FL �� <br /> Lot # <br /> sub �ivision CITY OF ZErHYRHILLS Parce� # 02- -- <br /> � Bio-Hazard Waste Storage - ANNUAL � <br /> � Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> a Fire Protection Maintenance - ANNUAL a PlaCes of Assembly-ANNUAL <br /> � r y emi � er ❑ <br /> Sprinkler � ❑ ❑ Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ O O�� � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL $25 00 <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q Other• <br /> Contractor � ; �,� � <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN <br /> Signature Company <br /> Registered Y/ N Fee Curcent Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> MECHANICAL <br /> Signature Company <br /> Registered Y/ N Fee Curcent Y/ N <br /> Address <br /> License # <br /> OTHER ,JERRY T BARR Company R N FIRE SPRINKL , INC. <br /> Signature <br /> tered Y N Fee Current Y N <br /> Address 2501 N. 7 TH T. TAM � <br /> �icense # 4 4 20 011��� <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 /> Suppiy two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />