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ais-�so-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> . ' Permit Application <br /> Date Received - �-� Phone Contactfor Permit 800 868 9151 <br /> "'iS:F2�:A� a. :xxYcea+d.••. �.. .°� A�tHe.i< a..o���e�@�:$ Q tv.u�iF V bRw��II�. '.y:4 a�G•ea^:' a�3S'�"�'he <br /> owner's Name Wal-Mart #706 Owner' Phone Number 813 782 1957 <br /> Owner's Address 7631 Gall Blvd, Zephyrhills, FL 33541 <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> &� �� <br /> Job Address 7631 Gall Bivd Lot # � <br /> Sub Division Parcel # <br /> ..� .>a;a .� :•:...s. > :•�. i�e.�';'�� ��° � . <br /> . _ . � � ` �.� `�. _ <br /> � BiaHazard Waste Storage - ANNUAL � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Comm Exhaust Kitchen Hood/Duct � Hood Installation <br /> � Controlled Burn � LP/Natural Gas-Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Emergency Generator > 30 kw � Places of Assembly-ANNUAL <br /> � Fire Protection Maintenance - ANNUAL � Recreational Burn <br /> ry emi �n er <br /> sprinkier �❑ ❑ ❑� X� Sparklers Inside Retail Sales of State Approved Sparklers <br /> Fire Alarm � ❑ ❑ ❑� � Sprinkler System installations <br /> Hood Cleaning � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) � �/ �± ( ( / <br /> �'/ �p « <br /> Hood Suppression � ❑ ❑ ❑� � Torch Roofing/Tar Kettle <br /> � Fire Alarm Installation � Waste Tire Storage ANNUAL <br /> � Fire Pumps <br /> �' Fire Works — $ PAQ,I��,.��5 <br /> � Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> � Other• <br /> ;�;��. , • •�� •�; ~�a:� .�� <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 <br /> License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> Vendor � Company NT Fireworks <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address 6255 SE 78th Street, Ocala, FL 34474 License # <br /> :�:� k���� . . . . . , , . ,.... ° w �°��� �� <br /> Directions: <br /> Fill out application completely <br /> Owner 8 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 $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained fr���l��(��r�1�p��.��1j$W� <br /> - Site plan at store - placement dictated by Fire Marshals office aY ZEPHYRHILLS � AL'S OFFICE <br /> - State Sparkler Licence attached Date: <br /> - Product List attached ��viewor: <br />