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813-628-0143 09 �4 09 a m 08-26-�Ot 3 10/1 S
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<br /> e�3-�eo-oozo Clty of Zephyrhllls Fire Faz-et3•780-OOZY"
<br /> Permit Application
<br /> Dete Recefved �
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<br /> o,�,mers Narr�e FLOFi1DA MEDICAL CLINIC Ownaf5 Phone Numher � � �
<br /> Owners Address 38135 MARKET S�UAf�E DR , ZEPHYRHILLS, FL 33542
<br /> Fee Simple Titleholder Neme Tltleholder Phone Number � � �
<br /> Fee Simpfe Tillaholder Address
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<br /> J�b Addresa 38051 MARKET SQUARE DR., ZEPHYRHILLS, FL �ot a �
<br /> suh Oivislon CITY OF ZEPHYRHILLS Pa�cel# 02-26-21-0010-03900-0020
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<br /> a8lo-Hazard Waste Storage-ANNUAL a Fumigatlon Tent
<br /> � Comm Exhausl Kllchen Hood/Duci a fiazardous Matenal(Tier II w RD Fanlity)ANNUAL
<br /> aCantrolled Bum � Hood Installation
<br /> � Emerc�ency Generator<3�kw � LP/Natural Gas-Instellatlon
<br /> � Emeryency Generator>30 kw O LP/Natural Gas-ANNUAL Sale
<br /> � F(re Protactlon Malntenance•ANNUAL O Places of Assembly-ANNUAL
<br /> t y emi � er �
<br /> Sprinkler � � ❑ ❑ � � Recreatlonal Bum �(� � I
<br /> Fire Alartn � ❑ ❑ ❑ � � Sperklers
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<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler Syslem Installations
<br /> Hood Suppresslon � ❑ ❑ ❑ � � Stantlpipes(Spnnkler Sys)
<br /> aFire Alarm IrtSlallaUOn O Torch RooMg/Tar KeIUe
<br /> � Fire Pumps O Wastc Tire Storogc ANNUAI
<br /> Fire Works
<br /> � Flemmable Application-ANNUAL $25.00 -, Valuatlon of Project
<br /> OFuel Tanks
<br /> Q Olher
<br /> Contractor Company ^ N=�.„ -,y'.1r .y_ �.-"
<br /> Signature Registerod Y/N Fee Cunent Y!N
<br /> Address License tl
<br /> ELECTRICIAN Company
<br /> Signawre Reginered Y/N Fee Gurcent Y!N
<br /> Address Llcense#
<br /> PLIIMBER Comparty
<br /> Signalure Registerad Y/N Fee Currenl Y/N
<br /> Addrase Llcanse#
<br /> MECHANICAL Campany
<br /> Signatura Registered Y/N Fee Currenl Y/N
<br /> Address Llcense#
<br /> OTHER JEFFERY D. BURNHAM Company RODAN FIRE SPRINKLERS, INC
<br /> Slgnecure Reglsterea Y/N Fee Curren� Y/N
<br /> Address 1 N. TH T. PA F 1 ��cense tt � �
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<br /> Directions. °���---'-
<br /> Fill oul applicaGon camplelely
<br /> Owner 8 Contractar cign back of appllcatlon,notanzad(Or,copy oi signed contrect wilh owner)
<br /> I!over 52500,a NaUce af Cammencement is reqwred(Mechanical work over 55000)
<br /> Supply Mro(2)sets of drawings with appllc�ble documenlaUon
<br /> Allow 1D-14 days tor ravlew aRer submittal dale. Pa2el tl-oblained from Prnperty Ta�c Notice(htip:/lappraiser pascogov.com)
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