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�,—� <br /> 813`-780-0020 Cit of Ze h rhills Fire <br /> Y P Y Fax-813-780-0021 <br /> Permit Application <br /> Date Received �� Phone Contact for Permit 800 868 9151 <br /> ��..��,.a:.,.m�.�_<., .._�,��.a�.��w.:��..�+.�,����.�.,. <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 Titleholder Phone Number C� �� � <br /> Fee Simple Titleholder Address <br /> . , . .,.,,R,�e >::x?,��,•s�-ars�F��.,..;.�f,„,e�. .,r..�t.ia.;M�;.�'.�b.p�e � <br /> Job Address 7631 Gall Bivd � <br /> Lot# <br /> Sub Division Parcel# <br /> �e ^v-:a�°��.x�Y�°-�'�.^�:, v.°ar,'x��°a��.. ,�.�,s:..��,,,saa���:�,asa;.'�"::yt•rm��.�s <br /> ` s+aF'�W+���;t.�a&: &t��i"& #� 3 <br /> Q Bio-Hazard Waste Storage-ANNUAL � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Comm 6chaust Kitchen Hood/Duct � Hood Installation <br /> � ConVOiled Bum � LP/Natural Gas-Installation <br /> a 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 /> ❑� emi �n � <br /> Sprinkler ❑ ❑ ❑ � � Sparklers Inside Retail Sales of State Approved Sparklers <br /> Fire Alarm � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Cleaning � ❑ ❑ ❑ C� � Standpipes(Sprinkler Sys) �� 1r 2 r D y� <br /> Hood Suppression � ❑ ❑ ❑ � � Torch RoofinglTar Kettle l fJ � <br /> � Fire Alartn Installation � Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> _� <br /> Flammable Application-ANNUAL Valuation of Projed <br /> � Fuel Tanks <br /> Q Other: <br /> •.Y.�.64Yi:.TA.a_t',:��FWI�X�eaF:is..$°a;s'.-"A:aw��::�k\«".k: .'�'�'.'BYi`"c; <br /> . 8',ddm3��'.4u�,.°9`sS�. <br /> Conhactor <br /> Company <br /> Signature Registered Y/N Fce Current Y/N <br /> Address <br /> license# <br /> ELECTRICIAN <br /> Company <br /> Signature <br /> Registered Y/N Fee Current Y!N <br /> Address <br /> License# <br /> PLUMBER <br /> Company <br /> Signature Registered Y/N Fee Cument Y/N <br /> Address <br /> License# <br /> MECHANICAL <br /> Signature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> Vendor <br /> Company NT Fireworks <br /> Signature Registered Y/N Fee Curnent Y/N <br /> Address 6255 SE 78th Street,OCala, FL 34474 license# <br /> . . . . , .,..3 L:.S.x'4.�i:4`ia..': �:,i'f&w.�g... <br /> Directions: ' -�. - .. � . <br /> Fill out application completely. /l -� <br /> Owner 8 Contractor sign back of application,notarized(Or,copy of signed contract with owner) 4��p f�r(,-L� �'�e- <br /> If over$2500,a Notice of Commencemerrt�is required(Mechanical work over$5000) � `�� fj� <br /> Supply rivo(2)sets of drawings with appflcable documentation �`�� <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Pro �� <br /> perty Tax Notice(http://appraiser.pascogov.com) <br /> -Site plan at store-placement dictated by Fire Marshals office <br /> -State Sparkler Licence attached <br /> -Product List attached <br />