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aia-�eo-oozo City of Zephyrhtlls Fire <br /> Pertnit Application Fax-813-780-0021 <br /> Date Received 2/26/2013 Phone Contact for Permit 813 313 1611 <br /> Owner's Name Communi Care Mobile Office Buildin Owner's Phone Number �� � <br /> Owner's Address 38240 DAUGHTERY R'ZEPHYRHILL FL 33540-1367 <br /> Fee Simple Titleholder Name Titleholder Phone Number ��� � <br /> Fee Simple TiUeholder Address <br /> Job Address Lot# � <br /> Sub Division <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 � <br /> � Emergency Generator>30 kw LP/Natural Gas-Installation <br /> � LP/Natural Gas-ANNUAL Sale ,/ <br /> Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL � �� /y <br /> Sprinkler ���m� �% J� <br /> � � � 0 Recreational Burn <br /> Fire Alarm <br /> ❑ ° X 0 � Sparklers <br /> Hood Cleaning � ❑ ❑ �� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � �� Standpipes(Sprinkler Sys) <br /> ❑ Fire Alarm Installation 0 Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> � Flammable Application-ANNUAL <br /> � Valuation of Pro�ect <br /> Fuel Tanks <br /> ❑ Other <br /> Contractor Wanda Paradis Comp Sim lex Grinnell <br /> Signature <br /> Regist Y/N Fee Cui Y/N <br /> Address 4701 Oak Fair Blvd,Tam a FL 33610 License# <br /> ELECTRICIAN <br /> Signature � Company <br /> Regist�_Y/N � Fee Cui Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Signature Company <br /> Regist�_Y/N � Fee Cu Y/N <br /> Address — — <br /> License# <br /> MECHANICAL <br /> Signature � Company <br /> Regist�_Y/N � Fee Cu Y/N <br /> Address — <br /> License# <br /> OTHER <br /> Signature Compa� <br /> Regist�Y/N J Fee Cu Y/N <br /> Address <br /> 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 Pro e Tax Notice htt //a <br /> P rtY ( p: ppraiser.pascogov.com) <br />