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613-780-0020 City of Zephyrhdls Fire Fax-Bt3-780-0021 Permd Applica4on Date Received 2!6/2013 Phone Contact for Permit 813 313 1611 Owner's Name Florida Hos ital Ze h rhills Owner's Phone Number �� Owner's Address 7050 Gall Blvd ZEPHYRHILL FL 33541-1399 Fee Simple Tideholder Name TiUeholder Phone Number �� Fee Simple TiUeholder Address Job Address Lot# � Sub Division Parcei# � Bio-Hazard Waste Storage-ANNUAL 0 Fumigation Tent � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL � Controlled Burn � Hood Installation ❑ Emergency Generator<30 kw 0 LP/Natural Gaslnstallation � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale � ` � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL �� ��mL� � ( z� � Sprinkler � x ❑ ❑ � � Recreational Burn 1 1�-� Fire Alarm � ❑ ❑ ❑ � � Sparklers Hood Cleaning � � ❑ ❑ � � Sprinkler System Installations Hood Suppression � _ ❑ ❑ 0 � Standpipes(Sprinkler Sys) ❑ Fire Alarm Installation � Torch Roofing/Tar Kettle � Fire Pumps � Waste Tire Storage ANNUAL Fire Works Flammable Application-ANNUAL Valuation of Project ❑ Fuel Tanks ❑ Other Contractor Wanda Paradis Comp Sim lex Grinneil Signature Regist Y/N Fee Cu Y/N Address 4701 Oak Fair Blvd Tam a FL 33610 License# ELECTRICIAN Compan Signature � Regist Y/N Fee Cu Y/N Address License# PLUMBER Compan Signature Regist Y/N Fee Cu Y/N Address License# M EC HAN ICAL Com pan Signature � Regist Y/N Fee Cui Y/N Address License# OTH ER Compan Signature Regist Y/N Fee Cui Y/N Address License# Directions: Fill out application completely Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) If over$2500,a Notice of Commencement is required(Mechanical work over$5000) Supply two(2)sets of drawings with applicable documentation Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)