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s�s-�so-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date R'eceived � f—'�j0---� � Phone Contact for Permit 800 868 9151 <br /> .. . .i:.R*T.ow &'31:. .�°':.... ..sr e �e. . . .. .v �.>..-... , f � i ., x. `3, -. 1. . x.. L. .. .� �� .. '.�XR �"d±?"t,' ��m'. . . . . . . <br /> Owner's Name K-Mart #3761 Owner's Phone Number $� 3 782 1957 <br /> Owner's Address 7422 Gall Boulevard, Zephyrhilis, FL 33541 <br /> Fee Simple Titleholder Name TiUeholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> �:.w� a. 'a';' .. ��.t� �, '?<w',�. _'k'�°'i`.� .>Ys,�= '��'" ��'"�. � <br /> Job Address �422 Gall Boulevard �ot # � <br /> Sub Division Parcel # <br /> <��• :;;�;�•'. :�:� :�F, t�w: a..�x�� s.h..�'�• ,r,Ai.�1rx :'� , s��ax�¢r •, ,.':� �:�#�"'t�°'<§�m.. x�a>.�, :�k�°a . •:�' , �' . �» . <br /> � Bio-Hazard Waste Storage - ANNUAL � Hazardous Material (Tier il or RQ Facility) ANNUAL <br /> � Comm F�chaust Kitchen Hood/Duct � Hood Installation <br /> � Controlled Burn � LPINatural Gas-Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-ANNUAL Sale �� 2(,p ( V <br /> � Emergency Generator > 30 kw � Places of Assembly-ANNUAL <br /> � Fire Protection Maintenance - ANNUAL � Recreational Burn <br /> ry emi �n t er <br /> Sprinkler �❑ ❑ ❑ 8 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 Installation � Waste Tire Storage ANNUAL <br /> � Fire Pumps <br /> � Fire Works — SPR�t�L �t'� � <br /> � Flammable Application- ANNUAL r Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> ...�R'�.` ..::���� •���vi�5: 5����� b.ikw� , .t�'��' . <br /> Contractor <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> Vendor Company TNT Fireworks <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address 6255 SE 78th Street, Ocala, FL 34474 License # <br /> ��A •�,��F=•�«� <br /> . .. . . . .. ., 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 rivo (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http:/lappraiser.pascogov.com) <br /> ;i[JBMITTED PLAN(S) HAVE BEEN REVIEW� <br /> - Site plan at store - placement dictated by Fire Marshals office �Y ZEPHYRHIL S RE ARSHAL'S OFFICE _ <br /> - State Sparkler Licence attached Date: �J <br /> - Product List attached <br /> ',�viewsr: <br />