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� CITY OF ZEPHYRHILLS
5335-8TH STREET
(si3)�so-oo20 13106
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 13106 Address: 5039 1 ST ST
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: 10-26-'`21-0010-12800-009
Improv. Cost:
Date Issued: 5/25/2012 Name: MIRA ENTERPRiSES
Total Fees: 25.00 Address: 5553 BRADDOCK DR
Amount Paid: 25.00 ZEPHYRHILLS, FL 33541
Date Paid: 5/25/2012 Phone:
Work Desc: FPM-ANNUAL HOOD SUPPRESSION FOR MAINE-LY NEW ENGLAND RESTAURANT
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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$100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECO IN Y R NOTICE
OF COMMENCEMENT." '
PERMIT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTlON -8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041
813-780-pp2�� c,ity or�epnyrnins rire
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- Permit Application
Date Received �--L y-(Z. Phone Contact for Permit
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Owner's Name A i n,� -� N t.e,cJ C� /� (��;�� ��
4��°' Owner's Phone Number u
Owner's Address
Fee Simple Titleholder Name �� � �
Titleholder Phone Number
Fee Simple Titleholder Address
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Job Address S a,3� �5� s� Z����S 3"3 S�/�
Lot# �
Sub Division
�: .., �� , �$�,�..,�,_, Parcel#
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� Bio-Hazard Waste Storage-ANNUAL � �`�� "
� Fumigation Tent
Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ F'acility)ANNUAL
� Controlled Burn � Hood Installation
� Emergency Generator<30 kw � -- ,
� LP/Natural Gas-Installation /�- " ,
Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale �
� Fire Protection Maintenance-ANNUAL � �f �
Places of Assembly-ANNUAL j
❑�rTy] emi �n er ❑ � f
Sprinkler ❑ ❑ ❑ Recreational Burn �
❑ ;� �� /�
Fire Alarm ❑ ❑ ❑ � � Sparklers ''�
Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations �.sc-''� ~J�
�..._
Hood Suppression � ❑ ❑ � C� � Standpipes(Sprinkler Sys)
� Fire Alarm Installation � Torch Roofing/Tar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
� Fire Works
� Flammable Application-ANNUAL
� Valuation of Project
Fuel Tanks
QOther:
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Contractor �.._�._--- �'.a�.� �..:.��,�:�
Signature . Company �� .�,� � _���
r Registered Y/N Fee Current Y/N
Address Q p _ .Ll Q�� � 3 G� License#
ELECTRICIAN
5ignature Company
Registered Y/N Fee Current Y/N
Address
License#
'LUMBER
iignature Company
Registered Y/N Fee CuRent Y/N
Address
License#
AECHANICAL
�ignature Company
Registered Y/N Fee Current Y/N
Address
License#
1THER
ignature Company
Registered Y/N Fee Cu�rent Y/N
Address
License#
irections:
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 htt //a
( p: ppraiser.pascogov.com)
NOTICE 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
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, 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
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(Chapter 713, Florida Statutes, as amended): If valuation of work is$2,500.00 or more,
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. 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 performed 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
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 AGEtVT 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
untess 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
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
PAYIN O R'�ENDER'OR AN ATTORNEY BEFORE RECORDING YOUR NOT CE O COMMENC MENT.' CONSULT
WITH Y
FLORIDA JURAT(F.S.117.03)
OWNER OR AGENT CONTRACTOR
Subscribed and sworn to(or affirmed)before me this Subscribed and swom to(or affirtned)before me this
by by
Who is/are personally known to me or has/have produced Who isJare personally known to me or has/have produced
as identification. as identification.
Notary Public
Notary Public
Commission No. Commission No.
Name of Notary typed,printed or stamped Name of Notary typed.Printed or stamped
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