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Home My WebLink About08-7684 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813) 780-0020 ANNUAL FIRE PROTECTION MAINTENANCE ~ Permit Number: 7684 Permit Type: FIRE PROTECTION MAINTENANC Class of Work: FIRE-PROTECTION MAINTENAN E Proposed Use: COMMERCIAL Square Feet: Est. Value: Improv. Cost: Date Issued: Total Fees: Amount Paid: Date Paid: Work Desc: Address: 5610 ALL BLVD ZEPHYRHILLS, FL. Township: Range: Book: Lot{s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 11-26-21-0010-05700-0255 3/28/2008 25.00 25.00 3/28/2008 Phone: FPM-ANNUAL HOOD CLEAN-BURGER KING-ALREADY COMPLETED Name: BURGER KING Address: 5610 GALL BLVD ZEPHYRHILLS, FL. 33542 h0J tJ..., () CO t{'/J Chapter 633, Florida Statutes, authorizes the City to charge and collect user fees to pay for the costs of fire prevention and protection related activities such as inspections, plan review, administrative fees, and other costs related to the aforementioned. Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final inspection shall be charged double permit fee per day of operation or a minimum of $100.00, whichever is greater. All work shall be performed in accordance with City Codes and Ordinances. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." .... P IT OFFICER PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPEcnON CALL FOR INSPEcnON - 8 HOUR NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041 ~<1l-\ T....... _,,": .,_ L.~,.~ ~. .... .,~ \,ir",:" ;:' ...:~ 'I.~ ...~ ~-'..-- .' - ;.-.; ~ fUo:!'Kl'~'iF.N'IlN(; ALEX SINK CHIEl; FINANCIAL OFt. leER STATE OF FI.oRIDA DATE: Mudl27th .2008 Please deliver the rollowin& page(s) to: :\ X\ IE PHO~E FAX ~ - - JACKIE @ City Of Zepll . ... 813-~1 . Seader's Name: :\.-\.'H~ PHONE FAX Cyatbia Sutton -Ins..ranee Sp-.... I - Division orWorken Co. atioll # 850-413-1811 # 858-921-2572 Number of pages, iadudiac tbis page: 3 Commeats or SpeeiallDstructioas: DIVISION OF WORKERS COMPENSATIONlCUSTOMERSUVlCE 200 EAST GAINES STREET. HARTMAN BUILDING, ROOM 308. TALLAHASSEE, FL 32399-4227 PHoNE: 800.742.2214. FAX: 850.921.2572 E0/10 39l;;1d 38I^~3S ~3wo~sn8 8M U9Z:IZ:6098 Iv:60 800Z:/LZ:/E0 . .~.,,~~ N011g~ONWBl::uDIfT ........1[ J~ ......~ f~T T...... n .. - .... f'" -'f ...,....................,............ .,- r1' 1.......-- II'~' - ___AI l.ttl'F".... ...,... 'II ~.V......'1I........... ...,_...,.... __01,.. "'r-,.... SECTION 1: () AppIiaIlt N_~print): ~~ a..~ b,< ~ '\?\-\, \\\ ~ ...................., _....or "'~W.....,...m: ~" I '\\4 _lIallt's........... <.....1): SEenOf' 2: I.......... ....._...... -. <Y- .... cIIeck...,....... .......): CONSTRUC11ON IND1JSTRY{UI nE RBQ1JIIIm) o Ofticerof. CoIpcnIion (TdIe): -OR. ~ M__ of. r llnlt.M u.biIiIy Compmy (LLC) NON-cDNSTJlUCI1ON JM)1)$I AY. (NO nz DQUIRED) o OftIaarofa CoIpandaa (TidIl): ) 1ba Divisima wIl KlCqlta ....,...... .c:aa.'s........ cIcdI.. ~.... payable to'" DFSWC ~ T... Fund. All oftIeer _ ..... a.. Ptorida ......... ...... .. bile.'" ..... dill _cnOJlf 3. To be eliaible far.. .-~IIi.nq. die carporaIiaD oCwhich you aN" ofticer or Ibe IiaIiIed IiItJiIty ClOIIIpIIIY orwhida you IN . JRaIIber IIIUIt be ....... with the Florida Division ofCorpcndcas. For .........applyiDa.... oJBcer of. ~,.,u1llUlt belillDd...oftbI' oflllo CarpcnIiae wiIb the FlaridaDiviliaa ofCorpcndcas. Lilt die document awnbel' (ctr-Mftt DIIIIIbIIr sboWD CIIl"'" Aaaual RIlport) OIl file with die Florida DlYiliaa ofCorparations. I 16o~~ SJCI'ION 4.. ~ eXCIIIpdaa appIicatioa...... 0D1y 10 1110 I!SD!!I si8J1ia11hD lppIicItioP. tile CorpantianILLC tbat it JisIecI below. and Cbe scope of......~ ~ N_ofCorpcnliOllor~: ~~ ~~~~~ _._ . FEIN:~"'-\~ Business N.ae: ~ ~ L ~\Q6_~ PhaGe: ( ) ...........-UII'~__IIOMG_d..... .u.-....dIllAllaCAIW Business MaiJinc Addnras:....:J. ~ 0 ~ O~ ~ \ - .......~..--- CIty: Se~~ \U!A... StaIe:;:L Zip: ~ ~~g~ County: ~,,~~~"- ScopeofBusineslorTndeofApplicant: I. \.\oDeD ~~..\." 2. 3. SECI'ION 5. List all cedified or ~ ""- isIued pUISUIIIIt to CbapIer 419. '.S. held by 1110 ....ana... die CCldifted or ,..... Ucease ......... bIId by 1IIe qUIIifier fix' die c:orponIion or u.c IisIed CIIlIbis IIJIPIIcaIioa of wIIich tile applkant is a CCNpclllleofticer: !I&L:a:a()N 6. Does die CCIUIIIy or ~ .......,... bI.BiBesi is 1.-1 ftlII1Ift" occu"".-_. .... tbr JOUr' bIBiness? Yes 0 No or YU,.to COPY OW.to CIJIUIDiT OCCUPAtJONALUcmSE MUST 8& ATrACUm. SECTION '7... AN you..... witb .., CCII6~.aiGn (including UC) 0lhIr 1ban tbo ~.riGD Q~~Idi.. LLC) 10 which tbis appIbdon 1ppIias? DYes'GJoHo II' YES," ~.6.tm LIST'" NAME(s) AND JI'EJN(.)O' no: An'ILIATBD COltPOllA'nON(I) OR LLC(a): NAID: nJN: SI'.CI"ION" (()VIII' ClOIfIOIlIIiaa or u.c is.,.... ill dID CCHDtrucIian inIIuIDy. you .....cwido Ibe JeqUired plOOf of owuenbip in ... ClOIpJI1ItioD ... lJ..C. A. To be eligible fOr a CDIIIIIUction iaduslry campCion . an ofticer of a COI)ICXIdion. the IIpplbnt must be a sMNholder. awaiDa- ...lCMof.....aof1blCGI~.....i. A COPY O' A STOCItcaTlftCATE EVIDENCINGTIIB UQUJRmOWNJ:RSIIIPMUST.. ATrACHED. B. To be eJiaible far a c;aastnICtioD UMUIIy CUIIIpdon .. member of aliJDiIed IiIbWty '*DpM)'. tbe appJ~ musr codrm ownmbip of.... 10% oCtile ~..,. TBB REQOJRED OWNDISII BY PRODUcnON O.IJOCUMDITATION UPLECflNG.... uoumm SUBMllTlNG A BrAT&IIBNT A:I-'..~G TO 'l1IE REQOJRED OWN MAR 13 'I'IIm Al'JlLlCAlION ISQJNTINUED ON PA.GE 2 1MC_.......___1O_.......-~_ 8UREf'~ €0/c;0 38\;td 38I^~3S ~3~OlSn8 8M USc;lc;60S8 lp:60 800c;/Lc;/€0 'L ~_BJ;ICnONTO_DDIP1"-'''''2 SBCrION'~. :PRA.IJD NOTICE A.. "~L.""''' -' *......................4&..........,. , 6'" 'r,n~ .t_..".....~.,r 1 ...t~L.___ ~J-..........~...........rilll......._ .'ter'~.....~...... .. ...- . "'" - ~- .---.n..&&.-.,..........--. -.-.....,...J.I!'-..-..:r --e7 . _""'_..- & J.~~'.,.PI'..:~- .._ ..' I': . .....1...... .......-....III.~.......-..IILJ,........f........ ....... -.. ..-~..~ 8Cf'JON:1I. YOUIDllBt""" .........' .....1 11.w..-............... __.. "'111111.......r,..- hi.. CardIr~ ....4WJ'OIr AftLIam"; r...,~'" -1IIIiet;.. ............- ............ .in f440.CJ2 Florida _., ... is !lUll_ QGmlCt1a ibo _a(my ofticos. ill.. ."'8 .. aII'iIiiIIIl o \ot. _ft_ NOTARY STATE OF Fl.ORlDA, .COtJNTY()p SWOmtolllld,..bs&:ribedhefonunelld& JpII}ay.~~tI1Pf1VJ M. p:.re-z PCJ'SOPIdJy KDown~ OR PIQduced I~~ L . . C 1Ihs-t. 1:.....1-- " "'2 J 2.0 12- ;nqp _ ~C!iJl.........._ ~ __ ...,.......... ...... . ..r ............. .. ~1tl4~_I..: .....-.:........ ... ,~-"1-..It_Jl_ -:--"Jijf.rr tfIJ-. ~; ~i...ii.......... . ...W ._..~~. ?W.Ii'~l >1iN .iIL... . ,.r-..,"v- _...... l1'U....~ .......... a.. ."..- .,.......(fal,.1UI m........iII...- . . j7-( ....w:...oi.t... . .._ jj'-~..r.~ .It!~_.._."'~ . 1ilf r.....tsM'''' __ .... ....VlJ..-.: .........~ ~..... Wl~: ........ ~ ......Iltl.... ..... ... .. all- " 11...." r-a.,._~'_"" Q..... T.........; ....... . T.......,.... ~.,..f-(M~ ----........-........-.......... E0/EI3 39'ii'd 38I^~3S ~3W01Sn8 8M . .., ""['''.....T .....w~ ... .......~ ....... ~,-lB51a' .. iiU..~ ..... ...... ...... .. .-:lliM.~-. ~._~ ...... "..rJ ~.: .~ ,~~.~- ,.....'*'....... t'IiW_ R.:12HIJrafi ~Tf''''' ...._~.... ,....... J"_~ 2II.Iiuf.GIiIiIIi ..... TtV ... 'JlL~'._ .T.........~ 4i3-1Rl .~DIbI:t · [ '~ 'DIia: .r ~~ -,- ~ 1.DIiIe- ~.f' . MAR I 3 2008 '~~MCE '--''If ':.'fi. \ - USc?;!c?;60S8 !v:613 81313c?;/Lc?;/EI3 81:1-78{}..Q020 Date Received Owner's Name Owner's Address Phone Contact for Permit City of.Zephyrhllls Fire Permit Application Fax-813-780-0021 f~!!^.,.t<I - ,(,.... f., _ ~~\D ~ Bo.\\ ??:>s "\, Fee Simple Titleholder Name 1 Owner's Phone Number ca.,) II ~~2-11 <t.,SD II II I TItleholder Phone Number r A.t:l_ -_,,1WiJIl ,~ vr-- Fee Simple Titleholder Address Job Address Sub DIvision ~..".,,_ ..---IM JU D D D D D ~ D o o o D D Contractor Signature Address ELECTRiCIAN Signature Address I I PLUMBER Signature Address I MECHAN'C.4. . Signature Addr~;s I OTHER Signature [ L J Lot# ~ Bia-Hazard Waste Storage - ANNUAL Comm Exhaust Kitchen HoodlDuct Controlled Bum . Emergency Generator < 30 kW Emergency Generator> 30 kw Fire Protection Maintenance - ANNUAL Spnn~er r==J Fire Alann D Hood CleanJSuppresslon ~ Fire Alarm Installation Fire Pumps Fire Works Flammable Application- ANNUAL Fuel Tanks Other: r Parcel # lUljIAINl:.U rKUM t"KUt't:KI Y IAA NUllv:L -" D Fumigation Tent o Hazardous Material (Tier II or RQ Facility) ANNUAl o Hood Installation D LP/Natural Gas-Installation o LP/Natural Gas-ANNUAL Sale D Places of Assembly-ANNUAL D Recreational Bum o Sparklers o Sprinkler System Installations o Standpipes (Sprinkler Sys) o Torch Roofing o Waste Tlfe Stocage ANNUAL I ., Valuation of Project I I I I I I _ ~__ c -] Company I Registered l I r I I f I I Y/N I Fee Current I Y IN I I I I I I I I ! I ~ . ~ddre~~J~..~.....'.~___ ~ ._~~_ _~~"'~~ ~ Directions: Fill out application completely. Owner & Contractor, sign back of application,notartzed (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 appllcable doc:umentallon Allow '\ 0-14 clays for review after submittal date. Ucense # Company Registered Fee Current I Y/N I Y/N LIcense # Company Registered Fee Current I Y/N I Y/N License # Company Registered Y / N I Fee Current Y/N Ucsnse # Company Registered License 11 l .... ___..~oI""".. ~___.",~'_-i~L.-.~Ir:"_ Fee Current I Y/N I Y/N NOTICE OF OEEb RESTRICTIONS: -The urKlersigned understands that this permit may be subjectio"'deedw restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility'forcompliance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR. RESPONSIBILITIES: If the owner has hired:a.' contractor or contractors to undertake work, they may be required to be licensed in accordance wlth stale and iocal regulations. \f the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the Pasco County Building Inspection Division--Licensing Section at 727-847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of ;the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the contractClr, .that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. I . CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If vatuation of work is. $2,500.00 or more, I certify that' I, the applicant, have been provided with a copy of the MFlorida Construction Lien Law-Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "owner', I certify that I have obtained a copy of the above described document and promise in good faith to deliver It to the "owner" prior to commencement. : CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation'has commenced prior to issuance of a permit and that all work will be performeq to . meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the Jurisdiction. I also certify that I understand that the regulations of other I government agencies may apply to the intended work, and that it is my responsibility to identify what actions I ',must take to be in compliance. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, ~igns, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shan be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside apy provisions of the technical codes, nor shall issuance of a permit prevent the BuDding OffICial from thereafter requirin~l a Forrection of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorJzed by the pemlit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned. I WARNING1tO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYIN(~ TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.' IF yOU INTEND TO OaTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTO NEY BEFORE RECORDI Y F OMMENCEME T. FLORIDA JURAT (F.S. 117.03) I OWNER OR AGENT . Subscrlbe!d and sworn to (or affinned) before me this .by Who Is/are petsonaJly known to me Of haslhave produced ! as identification. ! '." - ... ~~-~ -..:,"~-~~--- _..;-:,~--"-. ... CONTRACTOR Subscribed and s by Who is/are personally known to me or has/have produced as Identification, Notary Public Notary Public , Commission ~o. \ Commission No_ ----.-----..- Name of lNotarY typed, printed or stamped I I Name of Notary typed. printed or stamped < ~~~~~@I ity of Zephyrhills i ~.. "-' \