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1 <br /> I <br /> _. � 813 780-0020 City of Zephyrhills Fire Fax-813-780-0021 �� <br /> Permit Application <br /> Date Received Phone Contact for Permit 800� 868 9151 <br /> i�:r-��----.,�----� �.._ �,_,_�__. .�.,._.... _.^���.�.-.�.�^�:.w._...�.._� �..�,..� ._ _.___, ..._u - __._., <br /> Owners Name Wal-Malt#706 Owner's Phone Number � 813 782 1957 <br /> Owner's Address 7631 Gall Blvd, Zephyrhills, FL 33541 <br /> Fee Simple Titleholder Name Titieholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> I _'..'_..�.�-. '....."...,_.—,-.."�"""�." - - - �.-"T'z <br /> Job Address 7631 Gall Blvd �ot# � <br /> Sub Division Parcel# <br /> �'.°'.°..' ,- .�._....,._. _.._..._...�.._...�_..�..... ......_..,.�d ..�.._.v,_..___.�___ ,_._..._�_........� _.— -�=^� <br /> � Bio-Hazard Waste Storage-ANNUAL � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Comm Exhaust Kitchen Hood/Duct � Hood Installation <br /> � Controlled Bum � LP/Natural Gas-Installation - /n Q,�� <br /> � Emergency Generator<30 kw � LP/Natural Gas-ANNUAL Sale l(l'/(��J <br /> � Emergency Generator>30 kw � Places of Assembly-ANNUAL � <br /> � Fire Protection Maintenance-ANNUAL � Recreational Burn <br /> tr y emi �n t er <br /> sprinkler � ❑ ❑ ❑ X❑ sparklers Inside Retail Sales of State Approved Sparklers <br /> Fire Alarm � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Cleaning � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> Hood Suppression � ❑ ❑ ❑ � � Torch RoofinglT Kettle <br /> � Fire Alarm Installation � Waste Tire S o ANNUAL <br />� � Fire Pumps �i�� � � <br /> � Fire Works-SPARKLERS s � <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> L�- ,._...... _._._�._....u.._.� ._.._. ..�..� :.....��. ,.�^-•-----°��-------� <br /> Contractor Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature Registered l�/N Fee Current Y/N <br /> Address License# " <br />� PLUMBER Company <br /> Signature Registered Y/N Fee Curre�t Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br />� Vendor Company TNT Fireworks <br /> Signature Registered Y/N Fee Current Y/N <br /> Address 6255 SE 78th treet, Ocala, FL 34474 �icense# <br /> „r-�---_-___--�t.t��.... .._.�..< ._..,.____4_ _._.. � _�.......°~-----r°—:�..�:�u. _ - ...w,. - <br /> Directions: <br /> Fill out application completely <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> If over$2500,a Notice of Commencement is required(Mechanical work over$5000) <br /> Supply two(2)sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br /> -Site plan at store-placement dictated by Fire Marshals office <br />, -State Sparkler Licence attached , <br /> -Product List attached <br />