HomeMy WebLinkAbout400 N Entrance Rd 11-1684CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
of
Application No: I L Documented Construction Value: $ bZ 400
Job Address: YO() N &7 7 h-Qnce 2j Historic District: Yes No 9
Parcel W:12 4 11 3 U 3 U O 6 1 I .T UUU Zoning: (
Description of Work: lns+a PI Ft ee- SYS fvrt ! ,"l e" (dAfi 1460cl
Plan Review Contact Person: 'N'j W%J Title:
Phone: 401 3 a `-t. g3Q 3 Fax: D % 3 Z%f 82(4L E-mail: C T t, e 0--Q d'- C-OvK
Property Owner Information
Name 1 ocJne CenLe,, Ooi LA Phone:
Street: Q 0 30 ), 15Z?3 Resident of property? I I
J
City, State Zip: 6
Contractor Information
Name i)Za 1'i CL-V 4A/tQ & LA/'Yl.p#I+ Phone:
L+ 0-7 3 Z L( Y30 3
Street: E5 5. L_4La V-e, ( Gt'.y/`e_ Fax: t &)r7 3 2 S Z L I City,
State Zip: S A not) rA State License No.: la % LS"u U62 Name:
Street:
City,
St, Zip: Bonding
Company Address:
Building
Permit 0 Square
Footage: No.
of Dwelling Units: Electrical
0 New
Service - No. of AMPS: Architect/
Engineer Information Phone:
Fax:
E-
mail: Mortgage
Lender: Address:
PERMIT
INFORMATION Construction
Type: Flood
Zone: Mechanical
0 (Duct layout required for new systems) No.
of Stories: Plumbing
0 New
Construction - No. of Fixtures: Fire
Sprinkler/Alarm 0 No. of heads: 00
1
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 Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
q -I1
ignature of Contractor/Agent Date
PA 11i ( a,L
Print Contractor/Agent'sN e
Signature of N -S a of Florida Date
0,'"' k; Tii L. BRUCATO
MY COMMISSION M EE94907
EXPIRES: May 17, IOIS
aJ0MOTARY n Nomy Dim"AM=CL
Contra nown to Me or
Produced ID Type of ID
UTILITIES: WASTE WATER:
FIRE: BUILDING:
Rev 11.08
Date: -1 qq- . I - ) ..-- - -
ity oT Sanford
Suilditig. & Fife Pf'eventiO" Div'slo"
Fire Plan Review service Fees
Tel: 407.688-5050
Fax: 407.688.5051
Penviii 4:
Business or Projecl Name:
Addi-ess: YQ
Contact Name: Contact Ph-. L
Plan Review Information
UIGICIII Struction
Total Fees:
Cl (-,/0 f- I Fire Alarm 0 Fire Sprinkler Im- - Oocj L'I I ank ri Paint 13001h
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