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eis-�eo-oo2o City oiZephyrhills Fire Fu•813780.W21 <br /> ' Permit Applicadon <br /> D«a�„*te R�eived 5/7/2013 Phone Contact for Permit 813 313 1611 <br /> Owner"s Name FL Hos ital Ze h ills-Ctr Wound Care 8 H� rbar�� Owners Phone Number ��� <br /> Ovmer's Address 38233 OAUGHTERY RI ZEPHYRHILL FL 33540 <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titlehokier Address <br /> Job Address � <br /> Lot# <br /> Sub Division Parcel# <br /> � Bio-Hazard W aste Storage-ANNUAL ��� ��rr � Fumigation Tent µ <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> ❑ Controlled Bum � Hood Installation <br /> ❑ Emergency Generator<30 kw � LP/Natural Gas-Installation l �/� 2 <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale j � ,, / � <br /> � Fire Protection Maintenance-ANNUAL ��m� � pl��s of Assemby-ANNUAL L,Y� / <br /> �� <br /> Sprinkler � X� � � Recreational Bum <br /> Fire Alarm � � Sparklers <br /> Hood Cleaning � ❑ ❑ o � 0 Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ ❑ � O Standpipes(Sprinkler Sys) <br /> ❑ Fire Alarm Installation 0 Toroh Roofing/Tar Kettle <br /> Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application-ANNUAL <br /> Valuation of Project <br /> Fuel Tanks <br /> ❑ Other <br /> , w . , �,�,...,.,,.�wrs.,.Y�.... <br /> ConVactor� �Wanda Paradis Com Sim lex Grinnell ��� <br /> Signature Regist Y/N Fee Cu Y!N <br /> Address 4701 Oak Fair Btvd Tam FL 33610 License# <br /> ELECTRICIAN Company <br /> Signature � Repist�_ Y/N Fee Cu Y!N <br /> Address License# <br /> PLUMBER Company <br /> Signature Repistd_Y/N Fee Cu Y/N <br /> Address <br /> License# <br /> MECHANICAL Company <br /> Signature � Regist�Y/N Fee Cu Y/N <br /> Address License# <br /> OTHER Compan <br /> Signature Regist Y/N Fee Cu Y/N <br /> Address� <br /> License# <br /> Directions: .�.r,�„�..„�.,, ., -. e„ <br /> Fill out epplication completely. <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed conVact with owner) <br /> If over a2500,a Notice of CommencemeM is required(Mechanical work over$5000) <br /> Supply two(2)sets of drawings with applicable documentation <br /> Albw 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http:/lappraiser.pascogov.com) <br />