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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> , Permit Application <br /> Date k'eceived 1/30/2012 Phone Contactfor Permit 813 313 1637 <br /> Owner's Name FL Hospital Zephyrhills-Ctr Wound Care& Hyperbar Owner's Phone Number C 813 783 6106 <br /> owner's Address 7050 Gall Bivd,Zephyrhills FL. 33541 <br /> Fee Simple Titleholder Name Titleholder Phone Number C� � � <br /> Fee Simple Titleholder Address L— <br /> Job Address 38233 DAUGHTERY RD ZEPHYRHILLS FL 33540 � �� <br /> Lot# <br /> Sub Division <br /> Parcel# <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 Installation <br /> aEmergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL � <br /> � tr y emi �n t er ❑ � ^j� <br /> Sprinkler X ❑ ❑ Recreational Burn ! <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofingffar Kettle <br /> a Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> 0 Other� <br /> Contractor <br /> comPany SimplexGrinnell <br /> Signature Registered Y/N Fee Current Y/N <br /> Address 4701 Oak Fair Blvd., Tampa, FL. 33610 License# <br /> ELECTRICIAN <br /> Signature <br /> Company <br /> Registered Y/N Fee t:urrent Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Signature <br /> Company <br /> Registered Y/N Fee C;urrent Y/N <br /> Address <br /> License# <br /> MECHANICAL <br /> Signature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> OTHER <br /> Signature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <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 applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov com) <br />