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ais-�eo-oo2o City of Zephyrhills Fire Fax-B13-780-0021 <br /> Permit Appfiqtion <br /> Date Received Phone Contact tor Permit 813 621 1357 <br /> owners Name FLORIDA MEDICAL CLINIC Owners Phone Number C� �� � <br /> owner's Address 38107 MARKET SGIUARE DR.,ZEPHYRHILLS, FL 33542 <br /> Fee Simple Titlehotder Name Titleholder Phone Number C� � C� <br /> Fee Simple Titleholder Address <br /> Job Address 38107 MARKET SOUARE DR.,ZEPHYRHILLS, FL 33542 �ot# �� <br /> Sub�ivision CITYOFZEPHYRHILLS Perce�tt <br /> a Bio-Hazard Waste Storage•ANNUAL O Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct � Hazardous Maleriai(Tier il or RQ Facilily)ANNUAL <br /> a Controlled Bum O Hood Installation <br /> aEmergency Generator<30 kw O LPlNatural Gas-Installation <br /> � Emergency Generator>30 kw O LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL Q Places of Assembly-ANNUAL <br /> t y emi �n t er <br /> Sprinkler � ❑ ❑ � � � Recreational Burn �1 � <br /> FireAlarm � ❑ ❑ ❑ � � Sparklers � /��`JlJ <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fira Alarm Installation � Torch Roofing/Tar Kettle <br /> o Fire Pumps � Waste Tire Storage ANNUAL <br /> QFire Works <br /> OFlammable Applicalion-ANNUAL $25.00 Valuation of Project <br /> Fuel Tanks <br /> O Other: <br /> Contractor ' <br /> Company <br /> Signature Regislered Y/N Fee Gunenl Y/N <br /> Address <br /> License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License#t <br /> PLUMBER I"� <br /> Company � <br /> Slgnature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER compa�y RODAN FIRE SPRINKLERS, INC. <br /> signature JEFFERY D. BURNHAM � <br /> Registered Y/N Fee Curtent Y/N <br /> Address <br /> License# y <br /> Directions_ <br /> Fill oul application completely. <br /> Owner&Contractor sign back of application,notarized(Or,copy o(signed contract with owner) <br /> H over 52500,a Notice of Commencement is required(Mechanical work over 55000) <br /> Supply lwo(2)sets of drawings with applicable documentation <br /> Allow 10-14 days for review arier submittal date. Parcel#-obtained from Property Tax Notice(htlp:Uappraiser.pascogov.com) <br />