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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> ' Permit Application <br /> �ate Received Phone Contact for Permit 813 621 1357 <br /> . � . _ - . - . _... :�: ...... �- ,�.._ �.._ ,.�_. .... . . ...__ <br /> Owner's Name FLORIDA MEDICAL CLINIC Owners Phone Number 813 780 8440 <br /> owner's Address 38135 MARKET SQUARE DR., ZEPHYRHILLS, FL 33540 <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> , -�,.x�� �.�w a:,��w-�„a;�=,r:r�.m�.,�- ::�,;;��+�.x a;�-�z��r��Pa;r..�.:�,�sa:. .e�:�.�z.��r;�;a������ca�a€�a �, '� _ "�=�;�-°�! �;,`„z,= <br /> JobAddress 38135 MARKET SQUARE DR., ZEPHYRHILLS, FL 33540 �ot# � <br /> Sub Diwsion CITY OF ZEPHYRHILLS Parce�# 02- - - - - <br /> - � . � = . •,�- . .>a�,�• . ,�.�.�. . .. .��•:,�n. . <br /> a Bio-Hazard Waste Storage-ANNUAL a Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator<30 kw a LP/Natural 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 �n er <br /> Sprinkler � ❑ ❑ � � � Recreational Bum f��� <br /> Fire Alarm � O ❑ ❑ � � Sparklers ,�I � I <br /> Hood Cleaning � � ❑ ❑ � � Sprinkler System Installa ons � <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 /> � Fiammable Application-ANNUAL $25.�� Valuation of Project <br /> � Fuel Tanks <br /> 0 Other <br /> . � r , , :� ^��..�•*�; . '�..ze;: ,�9s.;.. r:uc,;s. .k,°�a.',3�"s-..K.,..r�%�a""��ma, ,-_ �.�e€.a:>.�t . � 2F=rz. .. -�-�.7�t.k�sffi.Yf�°e�, <br /> Contractor Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <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 Current Y/N <br /> Address License# <br /> OTHER JEFFERY D. BURNHAM /� company R N FIRE SPRINKL S, INC. <br /> Signature �'^ �-1 Registered Y N Fee CuRent !N <br /> Address 25 1 N. 70TH T. AM A FL 61 �icense tt 1 10 012 <br /> . . .. . - . . �.,. .<._w> - ., - . .. ...,. . x .a .�-��-�-��-:,-.�„ <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:/lappraissr.pascogov.com) <br />