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8�3-780-0020 City ofZephyrhdls Fire Fez-813-760-0021 <br /> Permit Apphcation <br /> Date Received 2/26/2013 Phone Contact for Permit 813 3'I3 1611 <br /> Owner's Name FL Hos Ze h rhills-Premier Sur Ctr Owner's Phone Number �� � <br /> Owner's Address 37834 Medicai Arts Ct ZEPHYRHILL FL 33541-4325 <br /> Fee Simple TiUeholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> Job Address � <br /> Lot# <br /> Sub Division 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 /> 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 � ❑ � � Recreational Burn / � ����� <br /> Fire Alarm � ❑ x ❑ � � Sparklers � <br /> Hood Cleaning � � ❑ ❑ � � Sprinkler System Installations l <br /> Hood Suppression � ❑ _ ❑ � � Standpipes(Sprinkler Sys) <br /> ❑ Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � 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 Regist Y/N Fee Cu Y/N <br /> Address 4701 Oak Fair Blvd,Tam a FL 33610 License# <br /> ELECTRICIAN Company <br /> Signature � Registd Y/N Fee Cui Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Company <br /> Signature Regist� Y/N Fee Cui Y/N <br /> Address <br /> License# <br /> M EC HAN ICAL Company <br /> Signature � Registd Y/N Fee Cui Y/N <br /> Address <br /> License# <br /> OTHER <br /> Company <br /> Signature Regist� Y/N Fee Cu Y/N <br /> Address <br /> License# <br /> Directions: " <br /> Fill out application completely <br /> Owner&Contractor sign back of appiication,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 />