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813-628-01a3 09 24 44 a m 08-�6-2013 1�/15
<br /> � B13•7BD-0020 City of Zephyrhills Fire Fax-Bt3-7B0-0D21
<br /> Permit Application
<br /> Dete Received Phone Can[ac!for Permit 813 2�
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<br /> owners Neme FL�RIDA MEDICAL CLINIC owners phone Number �_] � �_�
<br /> Owners Address 38107 MARKET SG�UARE DR., ZEPHYRHILLS, FL 33542
<br /> Fee Slmple Tilleholder Nama Titleholder Phona Number � � ��
<br /> Fae Slmple Titleholder Address
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<br /> Jab Addrese 38107 MARKET S�UARE QR.,ZEPHYRHILLS, FL 33542 �o�a �
<br /> SubDlvlsion CITY OF ZEPHYRHILLS Parcel�
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<br /> Q Bio-kaiard Wasta Storage-ANNUAL � Fumigatlon Tent
<br /> � Comm Exnaust Kllchen HoodlOuct � HazarUOUS Meterlal(Tier II or R�Fedllty)ANNUAL
<br /> � Cant�lled Bum � Hood InsteilaUon
<br /> aEmergency Generator<30 kw � LPINalural Ga�-Installatlon
<br /> � EmerBenty Generetor>30 kw a LplNatural Gas-lWNUAL Sale
<br /> OFre Prolectlon Malntenance-ANNUAL a Places of Assemhly-ANNUAL � Z
<br /> � emi � er � / � �
<br /> Spainkler � � ❑ ❑ B � RecreaUonal Bum �
<br /> Fire Alartn � O ❑ O � � Sparklers
<br /> Hood Gleaning � O ❑ ❑ � � Sprinkler System Inslalletions
<br /> Hoad Suppressian � ❑ ❑ ❑ � � Standpipes(Spnnkler SysJ
<br /> � Fire Alarm Inslellation O Torch Roofing/Ta�Keule
<br /> � Fire Pumps � Waste Tiro 6torage ANNUAL
<br /> OFue Works
<br /> � Ftammable Appllcation•ANNUAL $25.0� Valuation of Project
<br /> Fuel Tanks
<br /> � ��18f'
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<br /> Contractor �
<br /> Company
<br /> Signalure Repistered Y/N Fee Currant Y/N
<br /> Addfes5
<br /> Llcense tt
<br /> ELECTRICIAN Company
<br /> Signatura Reg�stered Y/N Fee Gurrent Y/N
<br /> Address Ll�ense ii
<br /> PLUMBER
<br /> Company
<br /> Slgnature Reglatered Y!N Fea Cu�ent Y/�)
<br /> Addres� License#
<br /> MECHANICAL
<br /> Company
<br /> Sigr�ature Registered Y/N Fee Current Y/N
<br /> Address llcense#
<br /> OTHER JEFFEF�Y D. BURNHAM Comparty RODAN FIRE SPRINKLERS. INC.
<br /> Slgnawre Registered Y 1 N Fee Current Y/N
<br /> Address � N. TH T. A P F 1 ucense p
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<br /> irections: ---- - . ._ ._.._... .
<br /> Fill out appliGatlon campielely
<br /> Owner 8 Contrector sign back ot application,notarized(Or,wpy of signed conUad with ownef)
<br /> If over E2500,a Motice o(Commencemertt is required(Mechanical wrnle over 3500D)
<br /> Supply iwo(2J sate of drewings with applicable documentetian
<br /> Ailow 10-14 days for review after submlttal dale Parcel#-obtained fmm Property Tax Notice(http;/lappralser.pasrogov.cam)
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