Laserfiche WebLink
� sis-�ao-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received � � Phone Contact for Permit 813 621 1357 <br /> , _ ,. �;�.s.,.� . . .r.. <br /> owner's Name FLORIDA MEDICAL CLINIC Owner's Pnone Number C� � � <br /> owner'sAddress 38107 MARKET SQUARE I�R., ZEPHYRHILLS, FL 33542 <br /> Fee Simple Titleholder Name Titleholder Phone Number C� � � <br /> Fee Simple Titleholder Address <br /> . � 's'. �f�-,g,:�',a'w'i°.�.�» - , ,ts:� �r:Y::�a'.�.. '9"�S'a�+q�.F:'.qs�g,^:*j:r r�n ' :4�';�`:'�.�:�k € a <br /> �_ �'^��:._..: <br /> JobAddress 38107 MARKET SQUARE DR., ZEPHYRHILLS, FL 33542 � �ot# � <br /> sub oivision CITY OF ZEPHYRHILLS Parce�# <br /> - . • r , t . a:�:�,�,�:�-�-,. ,.� , .,r .:..�� <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier II or RQ Far,ility)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 /> � Fire Protection Maintenance-ANNUAL � Piaces of Assembly-ANNUAL <br /> r y emi �n er <br /> Sprinkler � ❑ ❑ � � Recreational Burn ��� <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers � � <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Install tions <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys \ <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle � , i r� �� <br /> �1 v <br /> � Fire Pumps � Waste Tire Storage ANNUAL � �,"I <br /> � Fire Works <br /> � Flammable Application-ANNUAL $25 QQ Valuation of Project <br /> � Fuel Tanks <br /> Q Other <br /> ». � . ._rv . . '� .. . "'.•^5.°.k�:-r.a, a :"$P'4 a p,�<�Ma�� .. t .°`:Y'x:'`��'T`i'W1k��'!���`at't'i1'^�'E5°�' .. ..• .."�'. .� <br /> Contractor Company <br /> Signature Registered Y/N Fee Curcent Y/N <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address �icense# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y!N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Curcent Y!N <br /> Address License# <br /> OTHER JEFFERY D BURNHAM �_ /t—�'— Company R AN FIRE SPRINKLE , INC <br /> Signature Registered /N Fee Current Y N <br /> Address 2 1 N. 7 TH T. TAMPA FL 19 �icense# 1531 12 <br /> , ... . . . . _ .... . . . .<�__;. „ � , - u.. ., , _ . - . . . ,.�,x , <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 />