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813-�80-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Perrnit Application <br /> Date Received r--� Phone Contact for Permit 813 621 1357 <br /> : _ <br /> owner's Name FLORIDA MEDICAL CLINIC owner's Pnone Number 813 780 8440 <br /> Owner's Address 38135 MARKET SQUARE DR.,ZEPHYRHILLS, FL 33540 <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> .JobAddress 38135 MARKET SQUARE DR.,ZEPHYRHILLS, FL 33540 �a�p � <br /> sub oivision CITY OF ZEPHYRHILLS Parce�# 02-26-21-0010-03900-0030 <br /> � Bio-Hazard Waste 5torage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II ar R�Facility)ANNUAL <br /> aControlled Bum � Hood Installa[ion <br /> � Emergency Generator<30 kw a LP/Natural Gas-Instaliation <br /> Q Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> o Fire Protection Maintenance-ANNUAI a Places of Assembly-ANNUAL <br /> t y emi � er <br /> �i � ` <br /> Sprinkler � ❑ p �1 � Recreationel Burn / ��C/ <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers `f/ � <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installa[ions I <br /> Hood Suppression � p ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Inslaliation Q Torch Roofing/Tar Kettle //�V7'� � <br /> � Fire Pumps � Waste Tire Storege ANNUAL C�I � � '" � <br /> � Fire Works <br /> � Flammable Appiication-ANNUAL $25.00 � Valuation of Projeci <br /> FuelTanks <br /> QOther: <br /> Contrector Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address license# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# �- --� <br /> PLUMBER Company �� <br /> 5ignature Registered Y/N Fee Current Y 1 N <br /> Address <br /> License# <br /> MECHANICAL Company r <br /> Signature Regislered Y/N Fee Current Y!N <br /> Address license# <br /> OTHER JEFFERY D. BURNHAM ComPany RODAN FIRE SPRINKLERS, INC. <br /> Signelure Registered Y/N Fee Curcent Y/N <br /> Address license# 1 1 1 0 <br /> Directions <br /> Fill out application completely. <br /> Owner�Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> If over$2500,a Notice of Commencement is required(Mechanical woiic over$5000) <br /> Supply two(2)sets of drawings with appkcable documentation <br /> Allow�0-14 days for review after submittal date. parcel#t-obtained from Property Tax Notice(http:{/appraiser.pascogov.com) <br />