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( Z <br /> 813-780-0020 <br /> City of Zephyrhills Fire ��� Fax 813 - 780 - 0021 <br /> Permit Application <br /> Date Received I til / V to <br /> Phone Contact for Permit 0 868 9151 <br /> Owner's Name I Wal -Mart #706 1 Owner's Phone Number I 813 I I e 782 I 1 1957 ,., <br /> Owner's Address 1 7631 Gall Blvd, Zephyrhills, FL 33541 <br /> Fee Simple Titleholder Name I I Titleholder Phone Number 1 1 I <br /> Fee Simple Titleholder Address I <br /> Job Address 1 7631 Gall Blvd f Lot # <br /> Sub Division <br /> Parcel # <br /> I Bio- Hazard Waste Storage - ANNUAL a Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> n Controlled Burn n LP /Natural Gas - Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> I - 1 Emergency Generator > 30 kw n Places of Assembly- ANNUAL <br /> n F - ire Protection Maintenance - ANNUAL n Recreational Burn <br /> IQtrly) (Semi) (iii MEM <br /> Sprinkler E ❑ ❑ ❑ © Sparklers Inside Retail Sales of State Approved Sparklers <br /> Fire Alarm n Cl ❑ ❑ win: n Sprinkler System Installations <br /> Hood Cleaning n , 'E E 0 Standpipes (Sprinkler Sys) <br /> Hood Suppression 1.7L,IVO S . lit ` i I -- 1111 Torch Roofing/Tar Kettle <br /> 0 Fir � t , ,, _' 1 J Waste Tire Storage ANNUAL <br /> Fir rri r � i°..�- ; ' ('I -/ <br /> n F lamra�ation- ANNUAL I I Valuation of Project <br /> n F - uel Tanks <br /> In Other: I <br /> Contractor I <br /> Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address ( I License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current i Y / N I <br /> Address I <br /> License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> I License # <br /> Vendor /� / Company TNT Fireworks I <br /> Signature � — 1 . / Registered Y / N I Fee Current I Y / N <br /> Address 6255 SE 78 Street, Ocala, FL 34474 License # <br /> .�a. �., n •= a ..=�n �_.« �� ��, <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 />