HomeMy WebLinkAbout13-14491 CITY OF ZEPHYRHILLS
. 5335-8TH STREET
(si3��so-oo20 14491
ANNUAL FIRE PROTECTION MAINTENANCE
Permit Number: 14491 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: 8/29/2013 Name: GOLDEN CORRAL
Total Fees: 25.00 Address: 6855 GALL BLVD
Amount Paid: 25.00 ZEPHYRHILLS, FL. 33542
Date Paid: 8/29/2013 Phone: (813)783-8969
Work Desc: FPM- SUPPRESSION ANNUAL- 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$100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
"WARMING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUIR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE
OF COMMENCEMENT."
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PERMIT OFFICE
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041
813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
Permit Application
Date Received �f�Zq �(
Pho�e Contact for Permit �T(�j y96 b�6
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Owner's Name �o l�e.,,�, �ri�/�a.� Owner's Phone Number `B l 7� Sq6�
Owner's Address �a$�j (7-q I J� 2-���� t � 3J Stf z
Fee Simple Titleholder Name Titleholder Phone Number C� � ��
Fee Simple Titleholder Address
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Job Address �
Lot#
Sub Division Parcel#
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Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent .��T
� 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 � LP/Natural Gas-ANNUAL Sale
� Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
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Sprinkler � ❑ ❑ ❑ � � Recreational Bum
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Fire Alartn � ❑ O ❑ C� � Sparklers ��
Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
Hood Suppression � O ❑ � �� � Standpipes(Sprinkler Sys)
� Fire Alarm Installation � Torch Roofing/Tar Kettle
� Fire Pumps � Waste Tire Storage ANNUAL
� Fire Works
� Flammable Appfication-ANNUAL Valuation of Project
Fuel Tanks
Q Other:
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__ ::rY '«qT��',4§"�,'��..fM" f�.. ��$`$.
Contractor - Company �'�/�-/T��` /� c
Signature Registered Y/N Fee C�urrent Y/N
Address p,7, ,(yp ,C,�,,�6 pi F�3�f6� License#
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 Registered Y/N Fee Current Y/N
Address License#
�THER
Company
5ignature Registered Y/N Fee CuRent Y/N
Address
License#
�irections:
Fill out application completely
Owner&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(http:/lappraiser.pascogov.com)
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" r�strictions"
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 �equired 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'vif�lat{he
under state �aw. If the owner or intended contractor are uncertain as to what licensing requirements may app y
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,
ce�tify that I, the applicant, have been provided with a copy of the "Florida Construction Lien La cant�s someone
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the app'
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'S10WNER'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 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 affidavit prior to commencing construction. I understand that a separate permit may be required for eleclication�rA
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the app
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
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
PAYING TWICE FO R OR AN ATTORNE�BEFORE RECORDING YOUR NOTICE O COMMENCEMENT.' CONSULT
WITH Y�UR LEN�E
FLORIDA JURAT(F.S. 117.03)
OWNER OR AGENT CONTRACTOR
Subscribed and swom to(or affirtned)before me this
Subscribed and swom to(or affirmed)before me this bY
by Who is/are personally known to me or haslhave produced
Who is/are personally known to me or haslhave produced as identification.
as identification.
Notary Public
Notary Public
Commission No. Commission No.
rinted or stam ed Name of Notary typed,printed or stamped
Name of Notary typed,p p