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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit 877 740 — 6180 <br /> Owners Name Wal-Mart#706 Owner's Phone Number 813 782 1957 <br /> Owners Address 7631 Gall Blvd, Zephyrhills, FL 33541 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address 7631 Gall Blvd Lot# <br /> Sub Division Parcel# <br /> Bio-Hazard Waste Storage-ANNUAL a 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 <br /> try e_m ®Fff9 <br /> Sprinkler ❑ ❑ ❑ —1 Sparklers Inside Retail Sales of State Approved Sparklers <br /> Fire Alarm ❑ ❑ ❑ Sprinkler System Installations <br /> Hood Cleaning ❑ ❑ ❑ Standpipes(Sprinkler Sys) <br /> Hood Suppression El ❑ ❑ ❑ Torch Roofing/Tar Kettle V <br /> Fire Alarm Installation Waste Tire Storage ANNUAL <br /> F1Fire Pumps <br /> XX Fire Works-SPARKLERS <br /> Flammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <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 L 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 I Y/N Fee Current Y/N <br /> Address I License# <br /> Vendor Company ITNT Fireworks <br /> Signature Registered I Y/N Fee Current Y/N <br /> Address 6255 SE 78th Street, Ocala, FL 34474 License# <br /> Directions: <br /> Fill out application completely. <br /> Owner i£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 />