Laserfiche WebLink
a�3-�ao-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit 813 621 1357 <br /> owner's tvame FLORIDA MEDICAL CLINIC Owner's Phone Number 813 780 8440 <br /> owner'sAddress 38135 MARKET SQUARE OR., ZEPHYRHILLS, FL 33540 <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titlehotder Address <br /> JobAddress 38135 MARKET SQUARE DR., ZEPHYRHILLS, FL 33540 �ot# � <br /> sub�ivision CITY OF ZEPHYRHILLS Parcel tt 02-26-21-0010-03900-0030 <br /> � Bio-Hazard Waste Storage-ANNUAL a Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Instailation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Instaliation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> aFire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL �� � <br /> ry emi �n er � � l) , <br /> Sprinkler � � p ❑ � � Recreationai Burn i ; <br /> ` r <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers ��—��f <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � � ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Instailation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL $25.QQ VaNuation of Project <br /> Fuel 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 � <br /> License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> 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 H T. A �icense# 1 1 <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 /> Suppiy 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 />