Laserfiche WebLink
Ciry of Zephyrhills Fire Fax-aia-�eaooz� <br /> 813-780.0020 <br /> Permit Application <br /> Date Received 2l26/2013 Phone Contact for Permit 813 313 1611 <br /> Owner's Name Florida Hos ital Ze h rhills Owner's Phone Number �0 � <br /> Owner's Address 7050 Gall Blvd ZEPHYRHILL FL 33541-1399 �� � <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address Lot# � <br /> Sub Division Parcel# <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn 0 Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL ` <br /> ���� �I ��1 S 5 <br /> Sprinkler ❑ � � Recreational Burn l <br /> �re Aler�'�, ❑ c x ❑ 0 � Sparklers <br /> Ho� � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression ❑ � ❑ ❑ 0 � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation 0 Torch RoofinglTar Kettle <br /> � Fire Pumps 0 Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <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 Compan <br /> Signature � Regist Y/N Fee Cw Y/N <br /> Address �icense# <br /> PLUMBER Compan <br /> Signature <br /> Regist Y/N Fee Cu Y/N <br /> Address License# <br /> MECHANICAL Compan <br /> Signature � Regist Y!N Fee Cu Y/N <br /> Address License# <br /> OTHER Compan <br /> Signature Regist Y/N Fee Cw Y!N <br /> Address License# <br /> Directions: <br /> Fiil 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 />