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�� <br /> 813-780-0020 City of Zephyrhilis Fire Fax-813-780-0021 <br /> � ' Permit Application <br /> D�ate Received Phone Contact for Permit 800 868 9151 <br /> Owner's Name Publix # 1245 Owner's Phone Number 813 782 1957 <br /> Owner's Address 7838 Gall Boulevard, Zephyrhills, FL 33541 <br /> Fee Simple Titleholder Name Titleholder Phone Number � �� <br /> Fee Simple Titleholder Address <br /> �4�g , . <br /> Job Address 78� Gali Boulevard �ot # � <br /> Sub Division Parcel # <br /> � Bio-Hazard Waste Storage - ANNUAL � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Comm Exhaust Kitchen Hood/Duct a Hood Installation <br /> � Controlled Burn � LP/Natural Gas-Installation � / I 9� Z <br /> � Emergency Generator < 30 kw � < < <br /> LPlNatural Gas-ANNUAL Sale <br /> � Emergency Generator > 30 kw � Places of Assembly-ANNUAL <br /> � Fire Protection Maintenance - ANNUAL � Recreational Burn <br /> �y emi �n er <br /> Sprinkler �❑ ❑ ❑� X❑ sPa�ciers Inside Retail Sales of State Approved Sparklers <br /> Fire Alarm � ❑ ❑ p� � Sprinkler System Installations <br /> Hood Cleaning � ❑ O ❑� � Standpipes (Sprinkler Sys) <br /> Hood Suppression � ❑ ❑ ❑� � Torch Roofingffar Kettle <br /> � Fire Alarm Installation � Waste Tire Storage ANNUAL <br /> � Fire Pumps <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> .,��„��s., � <br /> ConVactor <br /> 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 �Q� ��(� company NT Fireworks <br /> Signature ��-� tw[ �" Registered Y/ N Fee Current Y/ N <br /> Address 6255 SE 78th Street, Ocala, FL 34474 �icense # <br /> Directions: � �.�� <br /> Fill out applicatan 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 y �� r'Y 1 <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained fromYr6 Z ���c�'�fi !8 r�i� p s` ov Lm� . <br /> A�iAit ' <br /> - Site plan at store - piacement dictated by Fire Marshals office i?ate: �� <br /> - State Sparkler Licence attached . - -� <br /> - Product List attached `e"��� �'� — --._ - . <br />