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a�s-�so-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date ReY�eived � 1/30/2012 Phone Contact for Permit 813 313 1637 <br /> Owner's Name Zephyr Haven Nursing Home Owner's Phone Number � 813 782 5508 <br /> Owner's Address 38250 A AVE, ZEPHYRHILLS, FL 33542 <br /> Fee Simple Titleholder Name Titleholder Phone Number [� �� � <br /> Fee Simpte Titleholder Address <br /> Job Address 38250 A AVE ZEPHYRHILLS FL 33542 � �ot# � <br /> Sub Division 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 /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-Ai�RUAL 5ale .� / <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL � �s�/ <br /> tr y emi �n t er ❑ � <br /> Sprinkler X� X ❑ ❑ � <br /> Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � 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 Valuation of Project <br /> Fuel Tanks <br /> X� Other Also (1)Annual Backflow inspection <br /> Contractor ����� Company SimplexGrinnell <br /> Signature Registered Y/N Fee Current Y/N <br /> Address 4701 Oak Fair Blvd.,Tampa, FL. 33610 �icense# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee��urrent Y/N <br /> Address License# <br /> OTHER <br /> Company <br /> Signature Registered Y/N Fee rurrent Y/N <br /> Address <br /> License# <br /> Directions: T- <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 />