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s»-�so-oo2o Ciry of Zephyrhiiis Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Raceived ' � Phone Contad fa Pertnit 813 621 1357 <br /> Owners Name FLORIOA MEDICAL CLINIC Owner's Phone Numbar �� � � <br /> ow�er�ndd�ess 38135 MARKET SQUARE DR.,ZEPhIYRHILLS, FL 33542 <br /> Fee 3lmpie Tideholder Name Tideholder Phone Number �� � C� <br /> Fee Simple Titleholder Address <br /> Jah Address 38051 MARKET SQUARE DR.,ZEPHYRHILLS, FL �oi� � <br /> sub Division C�TY OF ZEPHYRHILLS Parce�x 02-26-21-0010•03900-0020 <br /> OBio-Hezard Waste Siaage-ANNUAL � FumipaUnn Tent <br /> QComm Exhaust Kitchen Hood/Duct Q Hazatdous Materiai(Tier II or RQ Facility)ANNU�L._ <br /> Controlied Bum a Hood InsWllaUon <br /> QEmergency Generator<30 kw � LPMatural Gas-Inetallation <br /> QEmergency Generator>30 kw o lPMatu�ei Gas-ANNUAL Sa ppp��� <br /> QFire ProtecUon Maintenance-ANNIJAL O Places of AssemWyANMU 1l/'//� � <br /> �] erm �Tn er � 7 � <br /> Sprinkler � ❑ ❑ 0 � � RecreaGa�ai Bum — <br /> Fire Alertn � O ❑ ❑ � � SparWers <br /> Hood Cleaning � ❑ ❑ D � � Sprinkler System InstallaGons ,. <br /> Hood Suppression � p ❑ ❑ � � Standpipes(Sprinkier Sys) <br /> O Fire Alarm Instellation O Torch RoofinglTer Kettle <br /> Fire Pumps � Waste Tiro Storagc ANNUAL <br /> Fire WoHcs <br /> Flammable ApplicaUon-ANNUAL $25.00 , Valuation of Project <br /> QFuel Tanks <br /> � Other: <br /> CanUactw <br /> Company <br /> Signature Repistered Y(N Fee Cutrent Y/N <br /> Addrass <br /> License�f <br /> ELECTRICIAN � <br /> Campany <br /> Signawre Regis�ered Y!N Fee Currom Y!N <br /> Address <br /> Llcense q <br /> PLUM9Ef2 Compeny �'—" � <br /> SignaWre Registered Y/N Fee CuRent Y!N <br /> Address <br /> License# <br /> MECHANICAL C�p�Y � <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> licenae# <br /> OTHER JEFFERY D. BURNHAM �omveny RODAN FIRE SPRINKLERS,INC. � <br /> Signature Registered Y/N Fee Current Y!N <br /> Address 1 T T P F license# <br /> Directions: <br /> Fill out appllcadon completely. <br /> Oxmer 8 Contractor sign back af applicetion,notarized(Or,copy o!signed coniract with owner) <br /> If over 52500,e Notice ot Commencemenl is required(Mechanical wak over�5000� <br /> Supply 1wo(2)seta oI drawings with appiicabla dowmentation <br /> Allow f0-14 days for review aRer submittal date. Parcel#•obtained trom PropeRy Tax Notice(http:/lapp�aiser.pascogov.com) <br />