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813-780-0020 ity of Zephyrhills Fire Fax-813-780-0021 <br /> Permi� g��'A hills Fire <br /> 813-780-0020 � � � Fax-813-780-0021 <br /> Permit Application <br /> Date Received 8/1/2014 Phone Contact for Permit T 813 247 4777 <br /> _�--____.._._.�..��_ .� _...,_�,.,._..�_______....r_.._�.;�--_ ��............._.- __.__,_.�___-.�__.�.�.._....._�.._y�...__�__.._.�...�._.___._..��..__.._,�� <br /> Owner's Name Adventist Health System/Sunbelt Inc. owners Phone Number � � � <br /> Owner's Address 7050 Gall Bivd.,Zephyrhills, FL 33541 <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> t��'�.�-�a- - ° _ __�._.�m ..._._.. �.�� <br /> Job Address 7050 Gall Blvd.,Zeph rhills, FL 33541`� `N�ot# �� <br /> Sub Division Parcel# 35-25-21-0010-10500-0000 <br /> G.___._r_,�.._.._ _.Y.. ��.._v.�..__..___�__Wv..�. ...�.. _w_...m_..._.._..�.... ...._. --=_�'-�-' <br /> � Bio-Hazard Waste Storage-ANNUAL � � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> try emi n t er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Burn ,�� <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers °� <br /> J <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations � \� <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(SprinklerSys) h r,�"�§�;"� <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle !��4�' <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> I � Fire Works <br /> � Flammable Application-ANNUAL $12,496.00 Valuation of Project <br /> � Fuel Tanks <br /> Q Othef: <br /> �.�.._._.�..,..__..�__...._.�___� ___�__.w_�_e_.._w.�. ..___..__..__�.___....�_.._____._._.�_� - ��..___._...�.._._�.,.__...___.__�-- .� <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 Current Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER � � , /)��� � Company Cox Fire Protection, Inc. <br /> Signature ��✓(LG��-/ ���� Registered Y/N Fee Current Y/N <br /> Address 7910 Professional Place,Tampa, FL 336 7 �icense# 016982-0001-1985 <br /> _._ - .�.... .__�_�.�.__,_._._.m---.._.____..,__..... a._._....__.._ _�.__.�..��_._.�_.._ _._._._.�..� _�__.._..._..._._.___d____�-.—�s <br /> Directions: <br /> Fill out application completely <br /> Owner&Contractor sign back of application,notarized( ,copy of signed contract with owner) <br /> If over$2500,a Notice of Commencement is required(M chanical work over$5000) <br /> Supply two(2)sets of drawings with applicable document tion <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br /> : <br />