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&13-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit —1 800 868 F9151 <br /> Owners Name Publix#1245 Owner's Phone Number <br /> Owners Address 7838 Gall Boulevard,Zephyrhills, FL 33541 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> ------------ <br /> Job Address 7838 Gall Boulevard Lot# <br /> Sub Division Parcel# <br /> Bio-Hazard Waste Storage-ANNUAL Hazardous Material(Tier 11 or RQ Facility)ANNUAL <br /> 0 Comm Exhaust Kitchen Hood/Duct Hood Installation <br /> Controlled Burn LP/Natural Gas-installation <br /> F� Emergency Generator<30 kw LP/Natural Gas-ANNUAL Sale <br /> F-1 Emergency Generator>30 kw Places of Assembly-ANNUAL <br /> Fire Protection Maintenance-ANNUAL Recreational Burn <br /> F-1 r0fr yJ rTe-m"tl rA-nTl lother <br /> Sprinkler 0 0 11 X Sparklers Inside Retail Sales of State Approved Sparklers <br /> Fire Alarm 0 11 11 F7 Sprinkler System Installations <br /> Hood Cleaning F-1 0 11 0 7 Standpipes(Sprinkler Sys) all e3 <br /> Hood Suppression El 0 13 o F� Torch Roofing/Tar Kettle <br /> Fire Alarm Installation Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> F"q Fire Works -SPARKLERS <br /> . N <br /> F-1 Flammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Other: <br /> Contractor Company <br /> Signature Registered Y/N Fee Current y/N J <br /> Address License# <br /> ELECTRICIANI Company <br /> Signature Registered Y/N Fee Current LI/NJ <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICALF Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> Vendor Company ITNT Fireworks <br /> Signature Registered I Y/N Fee Current <br /> Address 16255 SE 78th Street, Ocala, FL 34474 License# <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(hftp://appraiser.pascogov.com) <br /> -Site plan at store-placement dictated by Fire Marshals office <br /> -State Sparkler Licence attached <br /> -Product List attached <br />