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s�3-�so-oo2o City of Zephyrhilis Fire Fax-813-780-0021 <br /> � . Permit Application <br /> Date Received ` � '` Phone Contact for Permit $�3 621 1357 <br /> Owner's Name FLORIDA MEDICAL CLINIC Owner's Phone Number � � � <br /> owner's Address 38135 MARKET SQUARE DR., ZEPHYRHILLS, FL 33542 <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> JobAddress 38051 MARKET SQUARE DR., ZEPHYRHILLS, FL �ot# � <br /> Sub Division CITY OF ZEPHYRHILLS Parce�# 02-26-21-0010-03900-0020 <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ F�acility)ANNUAL <br /> aControlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL fS'ale/! �U� �) <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembiy-AI�IUAL � ,/� <br /> r y em� �n er �.r�''� <br /> Sprinkler � � ❑ ❑ � � Recreational Burn `'p`;r <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers 'i� � �� � � - � <br /> � � <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) � <br /> � Fire Alarm Installation a Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Fiammable Application-ANNUAL $25.�Q Valuation of Project <br /> aFuel Tanks <br /> Q Other� <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 RODAN FIRE SPRINKLERS, INC. <br /> Signature �/`�" Registered Y/N Fee Current Y/N <br /> Address 1 7 T T A F 1 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 />