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613-6�8-0143 09 25 19 a m ��g_26-2013 14/15
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<br /> 813-78D•0020 City of Zephyrhllls Flra Fai-813-780-0021 ;%
<br /> Permit Application ,'`
<br /> Date Received Phone Conlaci for Pertnit 813 62� �357
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<br /> owners Name FLORIDA MEDICAL CLINIC OvmerS Phone Number 813 780 � � 8440
<br /> Owners Address 38135 MARKET SOUARE DR., ZEPHYR111LLS, FL 33540
<br /> Fee SlmpFe Titleholde�Nama Titleholder Phona Number � � �
<br /> Fee Slmple Titleholder Address
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<br /> JobAddresa 38135 MARKET SQUARE DR.,ZEPHYRHILLS, FL 33540 �otu �
<br /> sueDivision CfTY OF ZEPHYFiHILLS Parcel# 02-26-21-0010-03900-0030
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<br /> OBio-Hazard Weste Storage-lWNUAL � FumlgaUon Teni
<br /> � Comm Exhaust Kllchen HoodlDuct O Hazardous Meterial(Tler II or RQ Faciliry�ANNUAL
<br /> � Con�rnited Burn � Hood InslallaUon
<br /> � Emergenry Generelor<30 kw a LPMewrel Gaa-Inslellolion
<br /> � Emergency Generalor>30 kw a LP/Natural Gas-ANNLIAL Sale
<br /> � Flre ProtecUon Maintenance-ANNUAL � Places of AssamblyANNUAL �
<br /> �y emi �n er I�,/`. (Q
<br /> Spnnklcr � 0 ❑ ❑ � � Racreational Bum �`���
<br /> Fira Alerm � ❑ ❑ ❑ � � SparldeB �
<br /> Nood Cleaning � O ❑ ❑ � � Sprinkler System Installadons
<br /> Hood Suppresslon � ❑ ❑ ❑ � � Standplpes(Sprinkler Sys)
<br /> O Fire Alarm Installatlon O To2h Rooflng/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storegc ANNUAL
<br /> � Fra Worfcs
<br /> a Flammable Appllcation•ANNUAL $25.00 Valuatlan of Project
<br /> OFuetTanMs
<br /> � Other
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<br /> Contractor Compeny_..- � ---�,. .....,.. ......,�..u_.,...,.,.,.. ...,...---�- --
<br /> Slgnature Registerad Y/N Fee Cunent Y!N
<br /> Address Llcense# —�
<br /> ELECTRICIAN Company
<br /> signawre Reglstered Y/N Fes Current Y/N
<br /> Atldress Llcertse it
<br /> PLUMBER Company
<br /> SigneNre Registered Y!N Fee Current Y/N
<br /> Address Licensa q � ��
<br /> MECMANICAL Company
<br /> Signature Registered Y(N Fee Currertt Y(N
<br /> Address Llcense p
<br /> OTHER JEFFERY D BURNHAM company RODAN FIRE SPRINKLERS, INC.
<br /> Signature Registeretl Y/N Fee Cunent Y/N
<br /> Address � TH T 7 P 1 License p 83153100012006
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<br /> FIII out aAPliration complelely.
<br /> Owner 8 Contractor slgn back of applicatlon,notarizad(Or,copy ol slgned contrect with owner)
<br /> If over 52300,e Notice of Commencemertt is requlred(Mechanical work over ESD00)
<br /> Supply hvo(2)sets of drawings wilh applicable documenlaUon
<br /> Allow 10-14 days for review atler submiUal dale. Parcel t/•obtalned frnm Property TaY No�ce(http;!/appiaiser.pascogov.com)
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