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e�s-�ao-oozo City of Zephyrhills Fire Fax-813-780-0021 <br /> . • Permit Application <br /> Date Received � -2?"1 Z Phone Contact for Permit 800 868 9151 <br /> ,���a���.. <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 � � � <br /> Fee Simple Titleholder Address <br /> .i,:auN�1;«IUbu�cCSBn�eF'ac%i+ <br /> Job Address 7631 Gall Blvd Lot# � <br /> Sub Division Parcel# <br /> .m,.:„,�:e,��w�ti��w��.�w.��:,��ar�7a� <br /> � Bio-Hazard 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 � + 36�� <br /> � Emergency Generator<30 kw a LP/Natural 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� 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 /> aFire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other <br /> .:��.���� <br /> Contractor Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> ELECTRIC IAN 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 Company TNT Fireworlcs <br /> Signature Registered Y!N Fee Current Y/N <br /> Address 6255 SE 78th Street,Ocala, FL 34474 �icense# <br /> aaw�:+`wwww�unnwi <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 two(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 /> -Site plan at store-placement dictated by Fire Marshals office <br /> -State Sparkler Licence attached <br /> -Product List attached <br />