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I <br /> � st3aao-go2o • City of Zephyrhills Fire Fax-813-780-0021 i <br /> J' , � Permit Application <br /> Date Received —�p� � Phone Contact for Permit 800 868 9151 <br /> r-----•----�.•�_�__�__ -� . - <br /> Owners Name Wal-Mart#706 Owner's Phone Number 813 782 1957 <br /> Owner's Address 7631 Gall Blvd,Zephyrhills, FL 33541 <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> �-.. . _.__ ..._.,...�.--T..�.�._.. � <br /> . ,. . - . �. ::__.,,. -'...�..".�..e._-", <br /> .. .. _ . , <br /> , .. ._._. _ . <br /> I Job Address 7631 Gall Blvd � �ot tt � <br /> Sub Division Parcel# <br /> � � � _ _�.... ._.�'..� <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-InstallaUon <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 <br /> tr y emi �n er <br /> sprink�er � ❑ ❑ ❑ � X❑ spark�ers Inside Retail Sales of State Approved Sparklers <br /> Fire Alarm � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Cleaning � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) /� <br /> Hood Suppression � ❑ ❑ ❑ � � Torch Roofing/Tar Kettle �{�/J � �� <br /> _� � � <br /> � Fire Alarm Installation � Waste Tire Storage ANNUAL <br /> � Fire Pumps <br /> � Fire Works-SpARKLERS <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br />� �.-�~_-_- -r....._.�-�n°..-..---•----��..."._._...�____._.a..w. �..._ � _._...._....��:..,.,..._.. ___ _.__..�._.__.__.__..��.�.�..-.��.._..�:-� <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 /> Address 6255 SE 78th Street,Oca a, FL 34474 License# <br /> �.�_:—•--� .�_ ---�---�------� <br /> Directions: <br /> Fill out application completely. <br /> i Owner 8 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 />� <br />