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�A� <br /> s�s-�8o-002o City of Zephyrhilis Fire Fax-813-780-0021 <br /> , ' Permit Application <br /> Date Received Phone Contact for Permit 800 868 9151 <br /> s...a.3&?�'. : . ..i [�YP441 . . . . .. .. �Y�E'A.�F. .Y ii�}s•9.•.y3L.'�>5 kF.�'E. aks�•3�x;" xc�.. <br /> Owner's N�ime K-Mart #3761 Owner's Phone Number 813 782 1957 <br /> owner�s nc�dress 7422 Gall Boulevard, Zephyrhiils, FL 33541 <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> ���a'e�' :�:�3 <br /> Job Address 7422 Gall Boulevard Lot # � <br /> Sub Division Parcel # <br /> � :�Y��a; •� .'��__ � � , <br /> � Bio-Hazard Waste Storage - ANNUAL � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Comm Exhaust Kitchen Hood/Duct � Hood Installation <br /> � Controlled Bum a LP/Natural Gas-Installation �/� �� <br /> � Emergency Generator < 30 kw � LPlNatural Gas-ANNUAL Sale ' � j f f <br /> � �s�" l <br /> 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 Cleanin9 � � � ❑� � Standpipes (Sprinkler Sys) <br /> Hood Suppression � ❑ ❑ ❑� � Torch Roofing/Tar Kettle <br /> � Fire Alarm Installation � Waste Tire Storage ANNUAL <br /> � Fire Pumps <br /> � Fire Works <br /> � Flammable Application- ANNUAL � Valuation of Project <br /> Q Fuel Tanks <br /> Q Other: <br /> •�:�� _���. � �.�£�• . . a;�: , g:;; � <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 <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Addre:>s License # <br /> MECHANICAI_ Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> Vendor �, w. , , ' Company TNT Fireworks <br /> Signature ��' L�W [� �/l/ Registered Y/ N Fee Current Y/ N <br /> address 6255 SE 78th Street, Ocala, FL 34474 �icense # <br /> e�� :��<� <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 $�g� j�,fY�• pLAN S <br /> Supply two (2) sets of drawi�gs with applicable documentation � �� �)!!�►VE �EEN �tEVIEW <br /> Allow 10-14 days for review after submittal date. Parcel #- obtain� TrtMfPib�ti�� ppp9Y� <br /> �8[O; J U <br /> - Site plan at store - placement dictated by Fire Marshals office ��j�p,� <br /> - State Sparkler Licence attached <br /> - Product List attached <br />