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- � CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(sis) �so-oozo 12181
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 12181 Address: 7446 GALL BLVD
Permit Type: FIRE PROTECTION MAINTENANC ZEPHYRHILLS, FL.
Class of Work: FIRE-PROTECTION MAINTENAN E Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number:
Improv. Cost:
Date Issued: 7/29/2011 Name: SYBEA,INC.(ARBY'S)
Total Fees: 25.00 Address: 7446 GALL BLVD
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 7/29/2011 Phone:
Work Desc: FPM-SEMI HOOD CLEANING FOR ARBY'S
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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 $100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE
OF COMMENCEMENT."
�..
P IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
813=780-002D City of.Zephyrhills Fire Fax-813780-0021
'Permit Application
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Date Received Phone Contact for Pertnit
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Owner's Name ^ f � Owner's Phone Number �� �� I 4 9`� '7 I
n �i1�,LL! J
Owner's Address �� � � L � Z- -P yl� �..rG� [,. ..
Fee Simple Titleholder Name TiUeholder Phone Number �� ��
Fee Simple�TitleholderAddress
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Jab Address � � (J � � LS �G Lot # �
Sub Division Parcel #
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� Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent Y
� Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier il or RQ Facility) ANNUAL
� Controlled Bum � Hood Installation
� Emergency Generetor < 30 kw � LP/Natural Gas-Installation
� Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Sal r) I
� Fire Protection Maintenance - ANNUAL � Places of Assembly ANNU L �� J l �
� emi � er
Spnnkler � ❑ ❑ ❑ � � Recreatio�al Bum
Fire Alartn � ❑ ❑ ❑ � � Sparklers "
Hood Cleaning ❑ �C[ ❑� � Sprinkler System Installations
Hood Suppression ❑ D ❑� � Standpipes (Sprinkler 5ys)
a Fire Alartn Installation � Toroh Roofingrfar Kettle
� Fire Pumps � Waste Tire Storege ANNUAL
� Fire Works
� Flammable Application-ANNUAL /S', (P Valuation of Project
� Fuel Tanks
Q Other:
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Contractor � Company F$. IZ L -' �'vE 7'.,t' ,t, S 7.`
5ignature �� c � Registered Y/ N Fee Current Y/ N
Address (7(,V Q �p h/j � - (� D"�icense #
ELECTRICIAN Company
Signature � Registered Y/ N Fee Current Y/ N
Address License #
PLUMBER Company
Signature Registered Y/ N Fee Current Y/ N
Address
License #
MECHANICAL Company
Signature Registe2d Y/ N Fee Current Y/ N
Address License #
OTHER
Company
Signature Registered Y/ N Fee Current Y/ N
Address License #
Dir � . — ,
ections: �'
Fiil out application completely
Owner & Contrector sign back of application, notarized (Or, copy of signed contrect with owner)
If over $25��, 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 (http://appraiser.pascogov.com)
NOTICE OFDEED=RESTRICTIONS: +fhe undersigned understands this permit maybe�subject to "deed"
which may be�more�restrictive�than County�regulations. The undersigned assumes for compliance 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 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 contractor are uncertain as to what licensing requirements may apply for the
intended work, are advised to c�ntact 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
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
CONSTRUCTION LIEN.LAW (Chapter713, Florida Statutes,.as amended): If valuation of work is $2;500.00 or more, I
certify - that I, 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. ff the applicant is someone
other than the "owne�', 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 performed to
meet standards of all laws regulating construction, County and City codes, _z�ning regulations, and land
development regulations in the jurisdiction. 1 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 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, 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 to proceed with the work and not as authority 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 correction 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 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 Building Official for a period not to exceed ninety (90) days and will demonstrate
just�able cause for the extension. If work ceases for ninety (90) consecutive days, the j�b is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYINGTWICE FOR IMPROVEMENTS�TO YOUR PROPERTY. IF YOU INTENDTO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT CONTRACTOR
Subscribed and swom to (or affirmed) before me this Subscribed and bwom to (or affirmed) before me this
by Y
Who is/are personally known to me or has/have produced Who is/are personally known to me or has/have produced
as identification. as identlfication.
Notary Public Notary Public
Commission No. Commission No.
Name of Notary ryped, printed or stamped Name of Nohary iyped, printed or stamped