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ei�-�eo-oozo C' ofZe <br /> dy phyrhills Fire <br /> Peimft Appliratlon F.x-et 3�eaoozi <br /> D�ate Recei:�ed � 5/7/2013 � ,w�. - Phone Contact for Pertnit 813 313 1611 <br /> Owner's Name Ze h Haven Nursi Home � pwr�er's Phone Number �� � <br /> Owner"s Address 38250 A AVE ZEPHYRHILL FL 33542 <br /> Fee Simple TiUeholder Name Titlehokler Phone Number ���� <br /> Fee Simple Titlehol�r Address <br /> Job Address Lot# � <br /> Sub�Division Parcel# <br /> ������ BiaHazard Waste Storage-ANNUAL �a� � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> ❑ Controlled Bum 0 Hood Installation <br /> ❑ Emergency Generator<30 kw 0 LP/Natural Gas-InsTallation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL ��m� � p��s of Assembly-ANNUAL ��, (((��� /�/�'/ <br /> Sprinkler � o � 0 Recreational Bum � `% <br /> Fire Alarm 0 0 Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> ❑ Fire Alarm Installation 0 Torch RoofinglTar Kettle <br /> Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application-ANNUAL Valuation of Project <br /> FuelTanks <br /> ❑ Other <br /> Contractor ���Wanda Paradis � Com Sim lex Grinnell ������ <br /> Signature Regist Y/N Fee Cu Y!N <br /> Address 4701 Oak Fair Blvd Tam FL 33610 License# <br /> ELECTRICIAN Companv <br /> Signature � <br /> Repistd_Y!N Fee Cu Y/N <br /> Address <br /> License# <br /> PLUMBER Company <br /> Signature <br /> Regist�_Y/N Fee Cu Y!N <br /> Address License# <br /> MECHANICAL Company <br /> Signature � <br /> Regist�__Y/N Fee Cu Y/N <br /> Address License# <br /> OTHER Company <br /> Signature Regista_Y/N Fee Cu Y J N <br /> Address License# <br /> Directions: a,w=,M <br /> Fill out application completely. <br /> Owner&Contractor sign back of application,notarized(pr,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 />