HomeMy WebLinkAbout11-11531 CITY OF ZEPHYRHILLS /
• 5335 - 8TH STREET 11 531
' (813)780-0020
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 11531 Address: 6855 GALL BLVD
Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL.
Class of Work: FIRE-PROTECTION MAINTENAN E Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 03-26-21-0010-01600-0020
Improv. Cost:
Date Issued: 2/18/2011 Name: GOLDEN CORRAL
Total Fees: 25.00 Address: 6855 GALL BLVD
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 2/18/2011 Phone: (813)783-8969
Work Desc: FPM- HOOD CLEAN- GOLDEN CORRAL
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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."
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P IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
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City of Zephyrhills-Fir�• Fax-s�3aeo-oo2� .
, Permit Appiication -
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Date Received Phone Corrtact for Pertnit 4 . A r,. _ f✓ _, ^^_ ^ , N „y .
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Owners Name ANDERSON PRE S Owners Phone Number
Owner's Address 51�F ���' �� �� ��
Titleholder Phone Number
Fee Simple Titleholder Name
Fee SimpleTitlehoiderAddress ,�., s �-�?°��<�'
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JobAddress GOLDEN CORR.AL C7HSS GALI� BLVD. Z��H — Lot#
Paroel #
Sub Division , , �. - -��.�:€�;�'d�:>=�.�a `=�-�:::�.��:=�:�'"°�
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Q Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent
� Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier 11 or RQ Facility) ANNUAL
� Controlled Bum � Hood Installation
� Emergency Generator < 30 kw � LP/Natural Gas-Installation
� Emergency Generetor> 30 kw � LP/Naturai Gas-ANNUAL Sale
� Fire Protection Mairrtenance - ANNUAL � Places of Assembly-ANNUAL
�rTJ emi � � a
Sprinkler � ❑ O ❑ Recreational Bum I I �� I
Fire Alarm � � ❑ ❑ C� � Sparklers /�
Hood Cleaning � ❑ ❑ � C� a Sprinkler System Instaliations j X
Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkter Sys}
Q Fire Alartn Installation � Torch RoofinglTar Kettle
n Fire Pumps � Waste Tire Storage ANNUAL
U Fire Works
Flammable Applica6on-ANNUAL Valuafion of Project
L_J Fuel Tanks
� Other. =y �,��,... ; - �,_,;
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Contractor Company
Signature Registered Y/ N Fee Current Y/ N
Address License #
ELECTRICIAN Company
Signature
Registered Y/ N Fee Cu►rent Y/ N
Address License #
PLUMBER Company
Signature
Registered Y/ N Fee Current Y/ N
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 # ���� yp � � y
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Directions:
FII out appiication completely.
Owner & Contractor sign back of application, notarrzed (Or, copy of signed conVact wRh owner)
ff over S250Q, a Notice of Commencemerrt is required (Mechanical work over $5000)
Supply two (2) sets of drawings with applicable documerrtation
Allow 10-'14 days for review after submittal date. Par�el #- obtained from Pmperty Tax Notice (httpJlappraiser.pascogov.com)
NbTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions'
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicabie 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 with state and local regulations. If 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 coniractor are uncertain as to what licensing requirements may appty 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 #o have the contractor(s) sign
portio�s of the °contractor Block" of this application for which they will be responsible. if you, as the owner sign as fhe
contractor, that may be an indication that he is not properiy licensed and is not entitied to permitting privileges in Pasco
County. �
CONSTRUCTiON LIEN LAW (Chapter 713, Florida Statutes, as amendedj: If valuation of woric is $2,500.00 or more, I
certify that !, the applicant, have been provided with a copy of the "Florida 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", 1 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 AFFIDAYIT: i certify that all the information in this application is accurate and
that ali work wNi be done in compiiance with aii appiicab'le laws regulating construction, zoning and tand
developmen#. Application is hereby made to obtain a permit to do work and installation as indicated. I certify
that no work or instaliation has commenced prior to issuance of a permit and that ali work witl be performed to
meet standards of ali laws regulating construction, County and City codes, zoning regufations, and land
deveiopment regulations in the jurisdiction. I also certify that I understand that the regulations of other
� government agencies may apply to the intended work, and that it is my responsibility to identify what actions 1
', 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 aff+davit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license #o proceed with the work and not as autharity to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a coRection of eROrs in plans, construction or violations of any codes. Every permit issued shall become invalid
untess the Vvork autt�orized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit 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 Buiiding 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.
WARNiNG�TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAY ING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FiNANC1NG, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NQTICE OF COMMENCEMENT. .�,
FLORIDAJURAT (F.S. 117.03) ��= �t,�'!��'�°,� � . , � &=i`r �.%1!G• � e , a _ ,,� .: �:_-,�� _ : �f���
OWNER OR AGENT
CONTRACTOR -�� ` � �''�'-�—�'
Subscribed and swom to (or aflirmed) before me this Subscribed and � rrf to (or affim►ed) before me this
by
Who islare personally knovm to me or hasThave produc�d VVho is/are persona►ly known to me or has/have produced
as ideMification. as identification.
' Notary Public , Notary Public
Commission No. Commtssion No.
I Name of Notary typed. Printed or stamped
Name of Notary typed, piinted ar shdmped
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