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e�saao-oo2o City of Zephyrhilis Fire Fax-8�3-780-002t <br /> Permit Application <br /> Date Received ��� Phone Contact tw Permit 813 621 1357 <br /> wmer's tvame FLORIDA MEDICAL CLINIC Ow�efs Phone Numbet � � � <br /> owners address 1� 3�10?MARKET SQUARE DR.,ZEPHYRHILLS,�L 33542 <br /> Fee Simple Tttletwider Name 7itleholder Phone Number � � �� <br /> Fee Simple Tiqeholder Address <br /> Job Address 38107 MARKET SQUARE DR.,ZEPHYRHILLS, FL 33542 �ot t1 <br /> sut Division CITY OF ZEPHYRHIILS p��� �— _� <br /> � Bio-Hazerd Wesie Storaga•ANNUAL a Fumigetlon Tent <br /> � Comm Exhausl Kitchen HoodlDuct � Hazardous Materiat(Tier 11 or RQ Facility)/WNUAL <br /> � Controlled Bum a Hood Installetion <br /> QEmergency Generetor<30 kw a LP/Natural Gas-Insta�latlon � J���/� <br /> � Emargency Generator>30 kw � LPMatural Gas-ANNUAL Ss // <br /> a Fire Protection Ma+ntenance-ANNUAL � Plaees o(Assembly-ANNUAI <br /> !/ <br /> � em � er � <br /> Sprinkler � Q O �➢ � RecreaUonal Bum <br /> Fire Alartn � ❑ p ❑ � � Sparklers <br /> Hood Cleaning � O ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ O ❑ � � Sta�dpipes(Sprinkier Sys) <br /> oFire Alartn Installation Q Torch RooCngRar KetUe <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Worlcs <br /> � Fiammable Appilcation-ANNUAI. $2�,pp Valuation of Project <br /> Fuei Tanks <br /> QOther: <br /> Coniractor Company �—� <br /> SignaWre Registared _Y/N Fee Curcent Y 1 N <br /> Address license# <br /> E�ECTRIClAN Company �— <br /> Signature Registered Y/N Fee Cunenl Y/N <br /> Addrass License tl <br /> PLUMBER Campsriy �— <br /> Signature Reglsiercd Y/�1 Fee Gunent Y/N <br /> Address license# <br /> MECHANICAL Company r— <br /> Signature Registered Y/N Fee CuRent Y t N <br /> Address License# <br /> OTHER �EFFERY D. BURNHAM ComRany RODAN FIRE SPR NKLE S, INC. � <br /> Slqnamre Regisured Y/N Fee Curcent Y/N <br /> Addresa 1 N 7 T T. F License# 1 1 <br /> oi.ecuons: <br /> Flll out appUcaUon wmpietely. <br /> Owner 8 ConVacWr sign badt of appliceUon,nolarized(Or,copy of signed conUact with owner) <br /> If over 5250�,a Notice of Commencement is required(Mechanical work over 55000) <br /> Suppty two�2)seis of drawings with appllcaMe documentation <br /> Allow 10•14 deys for rev(ew arier submittal date. Parcel#-obteined 6om Properiy Tax Notice{http:/lappraiser.pascagov.com) <br />