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CITY OF ZEPHYRHILLS �
- 5335-8TH STREET
s (sis)�so-oo20 17015
' ANNUAL ASSEMBLY PERMIT
PERMIT INFORMATION - - � � .LOCATION�INFORMATION - ��
Permit Number: 17015 Address: 5841 GALL BLVD
Permit Type: FIRE PLACE OF ASSEMBLY ZEPHYRHILLS, FL.
Class of Work: FIRE-PLACES OF ASSEMBLY Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-00900-0130
Improv. Cost: - OWNER INFORMATION
Date Issued: 2/04/2016 Name: PROVIDENCE BESA LLC
� Total Fees: 50.00 Address: 9603 ORANGE JASMINE WAY
Amount Paid: 50.00 TAMPA FL 33647-3020
Date Paid: 2/04/2016 Phone:
Work Desc: PLACES OF ASSEMBLY- COMMANDOUGH'S LLC - EXP 2/2017
CONTRACTOR S � - � APPLICATION FEES
NER FIRE PERM T FEE 50.00
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- � � - Ins ections Re uired - � -
FIRE SITE I PE -Final
OCCUPANCY LOAD:
Occupancy by more than the number of persons above shall be considered
dangerous and unlawful. Occupant load determined by Florida Fire
Prevention Code, NFPA101, Section 7.3.1.2
PERMIT OFFIC
PERMIT EXPIRES IN ONE (1) YEAR FROM DATE OF ISSUANCE
THIS PERMIT NEEDS TO BE POSTED IN VISIBLE LOCATION IN MAIN ASSEMBLY AREA
ZEPHYRHILLS FIRE RESCUE DEPT - 6907 Dairy Rd, Zephyrhills, FL 33542
813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
Permit Application
Date�eceived� Phone Contact for Permit ��
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Owner's Name Q � Owners Phone Number �p�
Owner's Address ` L � '
Fee Simple Titleholder Name Titleholder Phone Number � � �
Fee Simple Titleholder Address 1
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Job Address Lot# ��
Sub Division Parcel#
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� Bio-Hazard Waste Storage-ANNUAL y� Fumigation Tent
� Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
� Controlled Bum � Hood Installation
� Emergency Generator<30 kw � LP/Natural Gas-Installation
� Emergency Generator>30 kw � /Natural Gas-ANNUAL Sale
� Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL
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Sprinkler � ❑ ❑ ❑ � � Recreational Bum
Fire Alarm � ❑ ❑ ❑ � � Sparklers
Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
� Fire Alarm Installation � Torch Roofing/Tar Kettle
� Fire Pumps a Waste Tire Storage ANNUAL
� Fire Works
� FlammableApplication-ANNUAL Valuation of Project
� Fuel Tanks
Q Other:
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Contractor � Company
Signature - �•-' Registered Y/N Fee Current Y/N
� Address License#
' ELECTRICIAN Company
Signature Registered Y/N Fee Current Y/N
Address License#
PLUMBER Company
Signature Registered Y/N Fee Current Y/�1
Address License#
MECHANICAL Company
' Signature Registered Y/N Fee Current Y/N
Address ` License#
OTHER Company
Signature Registered Y/N Fee Current Y/N
Address License#
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Directions:
i Fill out application completely.
Owner 8�Contractor sign back of application,notarized(Or,copy of signed contract with owner)
If over$2500,a Notice of Commencement is required(Mechanical work over$5000)
Supply two(2)sets of drawings with applicable documentation
Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(httpJ/appraiser.pascogov.com)