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�� <br /> � sis-7ao-oo20 � City of Zephyrhilis Fire Fax-813-780-0021 <br /> � Permit Application <br /> Date Received Phone Contact for Permit 800 868 9151 <br /> ...r�;�,��aa sas <br /> Owner's Name Wal-Mart #706 Owner's Phone Number 813 782 1957 <br /> Owner's Address 7631 Gall Blvd, Zephyrhills, FL 33541 <br /> Fee Simple Titleholder Name TiUeholder Phone Number �� � <br /> Fee Simple TiUeholder Address <br /> ����a�'�'�a•�8 a. � <br /> Job Address 7631 Gall Bivd Lot # � <br /> Sub Division Parcel # <br /> �w�. � <br /> � Bio-Hazard Waste Storage - ANNUAL � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Comm Exhaust Kitchen Hood/Duct � Hood InstallaUon <br /> � Controlled Bum � LP/Natural Gas-Installation , �il�Q � <br /> a Emergency Generator < 30 kw � LP/Natural Gas-ANNUAL Sale �� � <br /> Q Emergency Generator > 30 kw � Places of Assembly-ANNUAL <br /> � Fire Protection Maintenance -ANNUAL � Recreational Burn <br /> �y emi �n er <br /> Sprinkler �❑ ❑ ❑ X❑ Sparklers Inside Retail Sales of State Approved Sparklers <br /> Fire Alarm � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Cleaning � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> Hood Suppression � ❑ ❑ ❑� � Torch Roofing/Tar Kettle <br /> � Fire Alarm Installa6on � Waste Tire Storage ANNUAL <br /> � Fire Pumps <br /> � Fire Works <br /> Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> ,.;���� , � <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 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 Y/ N Fee Current Y/ N <br /> Address License # <br /> Vendor �,(� Company NT Fireworks <br /> Signature � w�/ Registered Y/ N Fee Current Y/ N <br /> Address 6255 SE 78th Street, OCala, FL 34474 License # <br /> �.�°� �. ;� <br /> y Directions: <br /> Fill out application completely <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed conUact with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2)�ets of drawings with applicable documentation �J� p�,pN S� AAVE �!E REVl�W <br /> Allow 10-14 da s for review after submittal date. Parcel #- obtained from Pro s�SC ZEPUCe ! a rai v�cQrn} , S OFFICE <br /> sri <br /> - Site plan at store - placement dictated by Fire Marshals office Date: <br /> - State Sparkler Licence attached }�a�,uW�.: <br /> - Product List attached <br />