HomeMy WebLinkAbout1417 WP Ball Blvd 12-952KDO 2 70tz
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
�2� - "I'S � Q°_
Application No: Documented Construction Value: $ ��
Job Address: ) Ll % �-)? j1 U CA Historic District: Yes ❑ Nolk
Parcel ID: Zoning:
Description of Work: ::104r_\k\ M ?- C- AA',� c P ` An
Plan Review Contact Person: '-' (aid -Ary- Title: le f%rA.ACC-
Phone: �1rJ� '�`�1 S�IoV Fax: qo-) 2:R0 5501-, E -mail: � �m�(amPl.c
Property Owner Information
Phone: q1 @)j n2) Q0?--z
Name 0_ 5
Street: i )CCU IIIanCP. 4-
City, State Zip: 36
Resident of property? :
Contractor Information
Name (a4 nCAP(N � JQ. GI`l\dpA( -�4 Phone: 5 � 0
Street: Pa &Z�k ` POQ I -7 Fax: ti r,o '3'11 S'; O b
City, State Zip: �[yxu 00 C� (c(\ State License No.: L i 0000 -) 6o
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Architect /Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Building Permit ❑
Square Footage: 152°1 Construction Type: No. of Stories:
No. of Dwelling Units: Flood Zone:
Electrical ❑ Plumbing ❑
New Service - No. of AMPS: New Construction - No. of Fixtures: _
Mechanical ❑ (Duct layout required for new systems) Fire Sprinkler /Alarm 14 No. of heads:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no
work or installation has commenced prior to the issuance of a permit and that all work will be performed to
meet standards of all laws regulating construction in this jurisdiction. I understand that a separate permit
must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers, heaters, tanks, and
air conditioners, etc.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE
OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this
property that may be found in the public records of this county, and there may be additional permits required
from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida
Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
Signature of Owner /Agent
Print Owner /Agent's Name
Date
Signature of Notary-State of Florida Date
Owner /Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Rev 11.08
UTILITIES:
FIRE:
Signature ofC r /Agent Date
�— /
P �-/ , � G
Print Contrac r /Agent's Name
I OJ+ULg IMM-t z/2.1 J I Z
Signature of Notary-State o lorida Date
L tary Public State of Florida
shley Moore
commission D0774729
pires 0410112012
Contractor /Agent is Personally Known to Me or
Produced ID Type of ID
WASTE WATER:
BUILDING:
=°P &Are hffuture
E L E C T R I C
Purchase Order
630 Kissimmee avenue S No. 612005 -4021
Ocoee. FL 34761
(407) 654 -0155 — Fax: (407) 654 -1455 02/21/12 612005 PAGE of
TO 1146 SHIP TO 16000 51400 16000
z
AMERICAN FIRE COMPANY GREAT CLIPS SANFORD
P.O BOX 520218 1417 WP BALL BLVD
SANFORD FL 32771
LONGWOOD, FL 32750
Terms & Conditions This purchase order is to be shipped in accordance with the
following conditions. All goods are subject to our inspection notwithstanding prior pay-
ment being made to obtain cash discounts. Merchandise that is found defective or not in
accordance specifications will be returned and freight charged both ways. Replacement
orders will require a new purchase order number. No charges will be allowed for packag
ing or cartage except as specified. This order must not be filled at higher prices than the
last quoted or billed price without prior approval
TOTAL► 500.00