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ai3-7ao-oo2o City of Zephyrhills Fire <br /> T Permit Appliwtion Fax-813-780-0021 <br /> Date Received 2/6/2013 Phone Contact for Pertnit 813 313 1611 <br /> Owner's Name FL Hos ital Ze h rhills-Ctr Wound Care&H erbar Owner's Phone Number ��� � <br /> Owner's Address 38233 DAUGHTERY RI ZEPHYRHILL FL 33540-1485 <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholdef Address <br /> Job Address � <br /> Sub Division Lot# <br /> Parcel# <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)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 � Places of Assembly-ANNUAL ��� <br /> Sprinkler ���m� y�/ � <br /> Fire Alarm � X � ° � 0 Recreational Burn �"r I <br /> ❑ � ° � � 0 Sparklers � <br /> Hood Cleaning ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps <br /> Fire Works 0 Waste Tire Storage ANNUAL <br /> � Flammable Application-ANNUAL <br /> Fuel Tanks <br /> Valuation of Project <br /> ❑ Other <br /> Contractor Wanda Paradis Comp Sim lex Grinnell <br /> Signature <br /> Regist Y/N Fee Cu Y!N <br /> Address 4701 Oak Fair Blvd,Tam a FL 33610 License# <br /> ELECTRICIAN <br /> Signature � Company <br /> Regist� Y/N Fee Cu Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Signature Compa� <br /> Regista Y/N Fee Cw Y/N <br /> Address — <br /> MECHANICAL License# <br /> Signature � Compay <br /> Regist Y/N Fee Cu Y/N <br /> Address <br /> License# <br /> OTHER <br /> Signature Company <br /> Regist�Y/N J Fee Cu Y/N <br /> Address <br /> Directions: License# <br /> Fill out application completely <br /> Ow�er$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 Pro e Tax Notice htt //a <br /> P rtY ( p: ppraiser.pascogov com) <br />