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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> '`-"—� Permit Application <br /> Date Receiv�d ' ' � Phone Contact for Pertnit 800 9 868 m 9151 <br /> r- - � _.._, �._......_._..._.�_ ....� �,..._...,,��_,�.v., --- .._.�. <br /> Owner's Name Wal-Mart#706 owner s Phone Number 813 782 1957 <br /> OwnersAddress 7631 Gall Blvd,Zephyrhills,FL 33541 <br /> Fee Simple TiUeholder Name TiUeholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> :=.____..� � __ --_-- - ._"-- - � �d� <br /> Job Address 7631��Gall BIVd� Lot# � <br /> u <br /> Sub Division Parcel# <br /> ��4 - -- __.� - - �.w_.___m_.,._� - — - - —� a--��--�-, <br /> � Bio-Hazard Waste Storage-ANNUAL � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Eomm Exhaust Kitchen Hood/Duet � Hood Installation <br /> � Controlled Bum � LP/Natural Gas-Installation <br /> � Emergency Generator<30 kw � LPlNatural Gas-ANNUAL Sale <br /> � Emergency 6enerator>30 kw � Places of Assembly-ANNUAL <br /> � Fire Protection Maintenance-ANNUAL � Recreational Bum <br /> � emi �n er <br /> Sprinkler � ❑ ❑ ❑ X❑ Sparklers Inside Retail Sales of State Appraved Sparklers <br /> Fire Alarm � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Cleaning � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> Hood Suppression � ❑ ❑ ❑ � � Torch Roofing/Tar Kettle <br /> � Fire Alarm Installation � Waste Tire Storage ANNUAL <br /> � Fire Pumps <br /> � Fire Works'SpARKLERS <br /> � FlammableApplication-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> � Other. <br /> r..w_._.��.�.,.________�..,�._ -_-���..�__,,.___...�����__e.: ---m-.-��.___R_ ._._.�.�...�_._._._�,._. _��-_---� -^-��.�--�;r� <br /> Contractor Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address ticense# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address ticense# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address ticense# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> Vendor Company TNT Fireworics <br /> Signature Registered Y/N Fee Current Y/N <br /> Address 6255 SE 78th Street,Ocala, FL 34474 �icense# <br /> �.....M" .�.c_ _ _ '-_...__,� ._...._..___....a�....+__. — ,..�.,._,a.�.d._��.�....e.ao�.._-.�-..�' rv.,:.�_. .`............�.._�..«_... .._..�..._......_._.r�...�.��...._..��.. ^v:.:e.,n'�-„'i"._"M..h <br /> Directions: <br /> Fill out application completely. <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> ff 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 Pire Marshals office <br /> -State Sparkler Licence attached <br /> -Product List attached <br />