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eia�eo-oozo Ciry of Zephyrhdls Fire Fax-813-780-002'I <br /> Permit Application <br /> Date Received 7l8/2013 Phone Contact for Permit 813 313 1611 <br /> Owner's Name Ze h r Haven Nursin Home Owner's Phone Number 0� 0 <br /> Owner's Address 38250 A AVE ZEPHYRHILL FL 33542 <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple TiUeholder Address <br /> Job Address Lot# � <br /> Sub Division Parcel# <br /> � Bio-Hazard Waste Storage-ANNUAL 0 Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Co�trolled Burn 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 � Places of Assembly-ANNUAL <br /> ����� 0 <br /> Sprinkler Recreational Burn <br /> Fire Alarm � ❑ X 0 � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ 0 0 Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ 0 � 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 Valuation of Project <br /> � Fuel Tanks <br /> ❑ Other <br /> Contractor Wanda Paradis Comp Sim lex Grinnell <br /> Signature Regist Y/N Fee Cui Y 1 N <br /> Address 4701 Oak Fair Blvd,Tam a FL 33610 License# <br /> ELECTRICIAN Compan <br /> Signature � Regist Y!N Fee Cui Y/N <br /> Address License# <br /> PLUMBER Compan <br /> Signature Regist Y/N Fee Cu Y/N <br /> Address License# <br /> MECHANICAL Compan <br /> Signature � Regist Y/N Fee Cui Y/N <br /> Address License# <br /> OTHER Compan <br /> Signature Regist Y/N Fee Cu Y/N <br /> Address 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 Property Tax Notice(http:!/appraiser.pascogov.com) <br />