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813-780-0020 City of Zephyrhills Fire Fax-613-780-0021 <br /> Permit Application <br /> Date Received � Phone Contact for Permit 813 621 Q 1357 <br /> owner's Name FLORIDA MEDICAL CLINIC Owner's Pnone Number � � � <br /> Owner'sAddress 38135 MARKET SQUARE DR., ZEPHYRHILLS, FL 33542 � <br /> Fee Simpte Titleholder Name Titlehoider Phone Number C� � � <br /> Fee Simple Titleholder Address <br /> , . _ .�•k�ox.. � - .,�n��*ac:d�...M,�,�^a� a�u..wi"'x:,�Y' 'R x:;A?* "�k�"� �TS* �'�44�:?.'y`�'- +af..S="'r'�'eea.. �'F8 <br /> �obAddress 38051 MARKET SQUARE�DR., ZEPHYRHILLS, FLp �ot# � <br /> sub oivision CITY OF ZEPHYRHILLS Parce�# 02- - - ' ' <br /> , ., ,,.�.. . .. ,� _. . ,. " r a . « � 'r ..... ^:s'�;."'�p�'.:,�c.`�: . ._ .. �'��;..°�„a,r , �7Wi .��. .,�e"' ..t'r - <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Fac:ility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LPlNatural 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 � � <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Instailations ' <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> aFire Works <br /> � FlammableApplication-ANNUAL $2�j.�� Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> ` r .. . %A � x ... ..-. " . "...'�s'.9t"�i�!5'°'`�Si'��Y.'.':.6'f'k���s�Y±'i�artR1''..y.E ^aE".:#*`er�'+t"�':T, ,�ri.1$:�Sr�:+r3!'£:. �:1Z!!'.z"��5��k�.'.'.tin tl&"�'�k..�--`-:'v5.h'rf'� " n'4 <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 AN FIRE SPRINKLE S, INC <br /> Signature � ~� Registered Y N Fee Current /N <br /> Address 2 1 N. 7 TH T. TAMPA FL 33 19 �icense# 31 1 12 <br /> , , .. , �. . .,�_ . . . . ,. �.> , . ._ . . . �_. . 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 applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http:l/appraiser.pascogov.com) <br />