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813- 780 -0020 City of Zephyrhills Fire ei' Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received 3 - 1O T tO Phone Contact for Permit 800 868 9151 <br /> Owner's Name I Wal -Mart #706 1 Owner's Phone Number I 813 I I 782 1 1 1957 I <br /> Owner's Address 1 7631 Gall Blvd, Zephyrhills, FL 33541 1 <br /> Fee Simple Titleholder Name I I Titleholder Phone Number ( 1 1 1 I <br /> Fee Simple Titleholder Address I I <br /> i <br /> Job Address 1 7631 Gall Blvd Lot # I <br /> Sub Division I I Parcel # I I <br /> 0 Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Comm Exhaust Kitchen Hood /Duct I-1 Hood Installation <br /> a Controlled Bum n LP /Natural Gas - Installation <br /> 0 Emergency Generator < 30 kw El LP /Natural Gas - ANNUAL Sale <br /> 0 Emergency Generator> 30 kw n Places of Assembly- ANNUAL <br /> 0 Fire Protection Maintenance - ANNUAL n Recreational Burn <br /> r y ME/ LEI MailI <br /> Sprinkler El ❑ ❑ ❑ © Sparklers Inside Retail Sales of State Approved Sparklers <br /> Fire Alarm [] ❑ ❑ ❑ ( 1 El Sprinkler System Installations <br /> Hood Cleaning 0 ❑ ❑ ❑ 1 1 n Standpipes (Sprinkler Sys) <br /> Hood Suppression 0 ❑ ❑ ❑ I 1 0 Torch Roofing/Tar Kettle <br /> 0 Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> 0 Fuel Tanks <br /> Q Other: I <br /> I <br /> Contractor Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address ( I License # I I <br /> ELECTRICIAN Company I <br /> Signature Registered I Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company I <br /> Signature Registered I Y/ N I Fee Current I Y/ N I <br /> Address I I <br /> License # <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address I /\ OL <br /> I License # I I <br /> Vendor Company ITNT Fireworks I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 6255 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 (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 />