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813 -780 -0020 City of Zephyrhills Fire Fax -813 - 780 -0021 <br /> Permit Application <br /> 1 <br /> Date Received I / 0., 7—n 9 I P Contact for Permit I 800 1 I 868 1 1 9151 <br /> j <br /> Owner's Name I Wal -Mart #706 I Owner's Phone Number I 813 I I 782 I 1 1957 <br /> Owners Address 1 7631 Gall Blvd, Zephyrhills, FL 33541 <br /> Fee Simple Titleholder Name I Titleholder Phone Number I I <br /> Fee Simple Titleholder Address 1 <br /> i i <br /> Job Address 1 7631 Gall Blvd <br /> Lot* <br /> Sub Division I 1 Parcel # I I <br /> E Bio-Hazard Waste Storage - ANNUAL 0 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Comm Exhaust Kitchen Hood/Duct El Hood Installation <br /> n Controlled Bum El LP /Natural Gas - installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Emergency Generator > 30 kw [J Places of Assembly ANNUAL <br /> ED Fire Protection Maintenance - ANNUAL n Recreational Bum <br /> Ltd I WEI MEM <br /> Sprinkler 0 ❑ ❑ ❑ © Sparklers Inside Retail Sales of State Approved Sparklers <br /> Fire Alarm 0 ❑ ❑ ❑ I 1 [] Sprinkler System Installations <br /> Hood Cleaning 1=1 ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> Hood Suppression E ❑ ❑ ❑ 1 I 0 Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation ED Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL I Valuation of Project <br /> Fuel Tanks <br /> Q Other: 1 I <br /> Contractor Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N I <br /> Address 1 1 License # ( 1 <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current 1 Y/ N I <br /> Address I I License* <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current 1 Y/ N 1 <br /> Address I <br /> I License # <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address 1 License* I I <br /> Vendor 1 Company TNT Fireworks I <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N 1 <br /> Address 16255 SE 78th Street, Ocala, FL 34474 I License* I <br /> 1 <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 $5o001 BMI1 „ I , �D PLAN (S) Supply two (2) sets of drawings with applicable documentation S t7 ( ) VE BEEN REVIEWED <br /> Allow 10 -14 days for review after submittal date. Parcel #- obtair$dfr,, Z ' . ?. '; -!! ;'., i. ,,: E <br /> Date: p io T� l — <br /> - Site plan at store - placement dictated by Fire Marshals office "(tel.! ' ' <br /> - State Sparkler Licence attached Reviewer. ' 50 <br /> - Product List attached <br /> r <br />