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• 813-780-002D City of Zephyrhills Fire Faz-813-780-0021 <br /> Permit Application <br /> Date Received r— � Phone Contacl for Permit 813 621 �357 <br /> owner's Name FLORIDA MEDICAL CLINIC Owners Phone Number � � � <br /> Owner's Address 38135 MARKET SGlUARE DR.,ZEPHYRHILLS, FL 33542 <br /> Fee Simple Titleholder Name Titleholder Pho�e Number C� � � <br /> Fee Simple Titleholder Address <br /> �ab a,ddress 38051 MARKET SOUARE DR.,ZEPHYRHILLS, FL �ottt � <br /> subDroision CITYOFZEPHYRHILLS Parce�t� 02-26-21-0010-03900-0020 <br /> � Bio-Hazard Waste Storage-ANNUAL a Fumigation Tenl <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> OControlled 8urn O Hood Installetion <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw O LP/Naturai Gas-ANNUAL Sale <br /> aFire Protection Maintenance-ANNUAL Q Places of Assembly-ANNUAL �� <br /> t y emi nl t er � � <br /> Sprinkler � ❑ ❑ � � � Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleening � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � Q ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> aFire Alarm Installation � Torch Roofing/Tar Keltle <br /> a Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Worics <br /> � Flammable Application-ANNUAL $25.00-� Valuation of Project <br /> � Fuel Tanks <br /> a Other: <br /> Con[ractor Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License p <br /> EIECTRICIAN � <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# �— --, <br /> PLUMBER Company �— <br /> Signature Re9istered Y!N Fee Current Y/N <br /> Address <br /> License# <br /> MECHANICAL Company � <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> OTHER JEFFERY D. BURNHAM company RODAN FIRE SPRINKLERS. INC. —� <br /> Signature Registered Y/IV Fee Curcent Y/N <br /> Address License# 1 <br /> Directions <br /> Fiil oul application completely. <br /> Owner 8 Contractor sign back oi application,notarized(Or,copy of signed contract with owner) <br /> If over$2500,e Notice oT Commencement is required(Mechanical work over SSODO) <br /> Supply lwo(2)sets of drawings with applicable documentalion <br /> Allow 10-14 days for review after submittal date. Parcel!I-obtained from Property Tax Notice(ht[p:Nappraiser.pascogov.com) <br />