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<br /> aisaao-oozo City of Zephyrhills Fire Fax-B13-780-0021
<br /> Permit Application
<br /> �ate Received 813 621 1357
<br /> Phana Contact for Permit
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<br /> owner's Name FLORIDA MEDICAL CLINIC Owner's Phone Number � � �
<br /> owner's Address 38107 MARKET SQUARE DR.,ZEPHYRHILLS, FL 33542
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address
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<br /> Jo6Address 38107 MARKET SG�UARE DR.,ZEPHYRHILLS, FL 33542 �ot# �
<br /> sub oivision CITY OF ZEPHYRHILLS Parce�#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facilityj ANNUAL
<br /> � Controlled Bum � Hood Installalion
<br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation
<br /> � Emergency Generator>30 kw � LPlNatural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL J�
<br /> � � tr y emi �n er ❑ /�(,` �
<br /> Sprinklar � ❑ ❑ Recreational Burn ( U
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<br /> Fire Alarm � O ❑ ❑ � � Sparklers
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation � Torch Roofinglfar Kellle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL ,
<br /> � Fire Works
<br /> � Flammable Application-ANNUAL $25.00 � Valuation of Project
<br /> � Fuel Tanks
<br /> � Other:
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<br /> Contractor 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 /> Signature Registered Y/N Fee Curre�t Y•/N
<br /> Address License#
<br /> MECHANICAL Company �
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> OTHER JEFFERY D. BURNHAM company RODAN FIRE SPRINKLERS, INC.
<br /> Signature Registered Y I N Fee Current Y!N
<br /> Address W Y V T A A P 1 �icense# 831 100 12006
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<br /> Direc[ions:
<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 work over$5000)
<br /> Supply two(2)sets of drawings with applicable documentation
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained irom Property Tax Notice(hrip:!/appraiser.pascogov.com) .
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