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� e��-Zao-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit 800 � 868 � 9151 i <br /> Owners 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 <br /> r--- ---�----:R--�- -�-----_-__---�--�--�:—.�>- S <br /> Job Address 7838 Gall Boulevard �ot# � <br /> Sub Division Parcel# <br /> . .a � ..,. ,._.._.._.._.:�.�.�':.....,��.._...� '-�___.�._._ ...._.�....__._._..s.. ..�...-------e <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 <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 Bum <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ 8 X� Sparklers Inside Retail Sales of State Approved Sparklers <br /> Fire Alarm � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Cleaning � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) �� 1 <br /> Hood Suppression � ❑ ❑ ❑ � � Torch RoofinglTar Kettle (�s I� <br /> V <br />, � Fire Alarm Installation � Waste Tire Storage ANNUAL <br /> � Fire Pumps <br /> �X Fire Works -SPARKLERS <br /> � Flammable Application-ANNUAL Valuation of Project <br /> I � Fuel Tanks <br /> Q Other: <br /> ��.._ �ft-_. _._.._..��.._. .�,.�:.�,.W—.�__:.��.� ---,�_,_.��.._ - _�.r___,`__,�_._�...�..._.�.�.�_w._..�..., .Y. - -:�, <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, Ocala, FL 34474 License# <br /> c--�~--�--�--�,....w ._.._._....�_�.�..�._.�_.._...,_._.._L...._...��... �..__.�.._._._�..�._.�._...._____._._....._..w-�::__...._..:�_..�.:_._.w�.__ __._�� <br /> Directions: <br /> Fill out application completely <br /> 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 />