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� "813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Received Phone Contaot for Pertnit $�3 621 1357
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<br /> owners Name FLORIDA MEDICAL CLINIC owner's Phone Number 8�3 780 8440
<br /> owner'sAddress 38135 MARKET SGIUARE DR., ZEPHYRHILLS, FL 33540
<br /> Fee Sfmple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Tiqeholder Address
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<br /> JobAddress 38135 MARKET SQUARE DR.,ZEPHYRHILLS, FL 33540 �ot�t �
<br /> sub Division CITY OF ZEPHYRHILLS Parce�# 02-26-21-0010-03900-0030
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<br /> . _...:.:._
<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigalion Tent
<br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier II or RQ Faciiity)ANNUAL
<br /> � Controlled Bum � Hood Installation
<br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation
<br /> � Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale
<br /> Fire Proteclion Ma(ntenance-ANNUAL � Places of Assembly-ANNUAL �j►
<br /> � t y em N t er �_V�
<br /> Sprinkler � � ❑ ❑ � � Recreational Bum ��
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers ^'
<br />, Hood Cleaning � ❑ ❑ ❑ � � Sprinkler Sys[em Installations
<br /> Hood Suppression � ❑ � ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Inslallation � Torch Roofing/Tar Keltle
<br /> � Fire Pumps � Waste Tire Storege ANNUAL
<br /> � Fire Works
<br /> � Flammable Application-ANNUAL $2�.00 Valuation of Project
<br /> � Fuel Tanks
<br /> Q Other:
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<br /> Contractor Company
<br /> Signature Regisiered Y/N Fee Current Y/N
<br /> Address Li�ense#
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Current 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 RODAI�! FIRE SPRINKLERS, INC.
<br /> Signature Registered Y/N Fee Curcent Y/N
<br /> Address 1 A W Y V I A A P �icense# 8315 100012006
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<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 52500,a Notice of Commencement is required(Mechanical work over 55000)
<br /> Supply two(2)sets of drawings with applicable documentalion
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http:f/appraiser.pascogov.com)
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