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' ais-�so-oozo City of Zephyrhills Fire Fax-813-780-0021
<br /> ` " Permit Application
<br /> Date Received Phone Contact for Permit 800 868 9151
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<br /> Owner's Name Publix#1245 Owners Phone Number 813 782 1957
<br /> Owners Address 7838 Gall Boulevard,Zephyrhills, FL 33541
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address
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<br /> JobAddress 7838 Gall Boulevard Lot# �
<br /> Sub Division Parcel#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Comm Exhaust Kitchen Hood/Duct � Hood Installation
<br /> � Controlled Burn � LP/Natural Gas-Installation
<br /> � Emergency Generator<30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Emergency Generator>30 kw � Places of Assembly-ANNUAL
<br /> � Fire Protection Maintenance-ANNUAL � Recreational Burn�
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<br /> Sprinkler � ❑ ❑ ❑ � � Sparkiers Inside Retail Sales of State Approved Sparklers
<br /> Fire Alarm � ❑ ❑ ❑ � � Sprinkler System Installations � n
<br /> � �� J
<br /> Hood Cleaning � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> Hood Suppression � ❑ ❑ ❑ � � Torch oofinglTar Kettle
<br /> � Fire Alarm Installation � W ire Storage ANNUAL
<br /> � Fire Pumps /C�� ��
<br /> � Fire Works -SPARKLERS v�"
<br /> � Flammable Application-ANNUAL Valuation of Project
<br /> Fuel Tanks
<br /> Q Other:
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<br /> Contractor Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Current 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 /> ,4ddress 6255 SE 78th Street, Ocala, FL 34474 �icense#
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<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
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