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HomeMy WebLinkAbout272 Towne Center Cir 01-1835 com int remodelO _ ty ��l�Ce)4-rC� tn SUBDIVISION �� �J le 1 0c,.)n �-P1) Tom/ AG. �/ v PERMIT ADDRESSi cn CONTRACTOR 10 S � C , ADDRESS G (� �l� ' !" L. �CLI nest; lle_ FL PHONE NUMBER 35 �, — - G � 03 PROPERTY OWNER 5e1y\ I'll 0 (e i�,,,�nP Cer4e Matl ADDRESS PERMIT # O) I gj�5_ DATE (�1' PERMIT DESCRIPTION PERMIT VALUATION d5l 0 OC7C7 SQUARE FOOTAGE 13 �P Perm 0. -Y- -r, �_ Wal is v 1- li PHONE NUMBER ELECTRICAL CONTRACTOR w W 6 MECHANICAL CONTRACTOR A II''11 O PLUMBING CONTRACTOR MISCELLANEOUS CONTRACTOR PERMIT NUMBER Fj FEE G� MISCELLANEOUS CONTRACTOR PERMIT NUMBER FEE ir. � ......._��.�: t_ .. �.u. .,� - - - --- - .- - - � - - -- - --- } - ,.1._ .ae, � —._a' •:�-. _._ '�•'v' -- --_ice - - - .��� .�_.r.. CITY OF SANFORD FIRE DEPARTMENT FEES FOR SERVICES PHONE # 407-302-1091 * FAX #: 407-330-5677 DATE: PERMIT #: V I — 1 W35 BUSINESS NAME / PROJECT: C-'' o)- b X I n Lr- t C k"-S :r- n .0 ADDRESS: Z '1 2 TO W -K 1L d d y, )l-n PHONE NO.: 3 SL� 3 3 Z - �, 5 03 FAX NO.: CONST. INSP. [ ] C / O INSP.:[ ] REINSPECTION [ ] PLANS REVIEW [ F. A. [ ] F.S. [ ] HOOD [ ] PAINT BOOTH [ ] BURN PERMIT [ ] TENT PERMIT ,. ] TANK PERMIT [ ] OTHER [ ] TOTAL FEES: $ % -)- -7 -2-3---- (PER UNIT SEE BELOW) COMMENTS: -;C -7 Ei rc 1' L A-- C e- r o ✓ A- ; aDn 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Address / Bldg. # / Unit # Square Footage Fees per Bldg. / Unit 1�'2, Towh4, c,£h3l%. C;/L1 /3L / ")--7• z� Fees must be paid to Sanford Building Department, 300 N. Park Ave., Sanford, FI. 32771 Phone # -407- 330-5656. Proof of Payment must be made to Fire Prevention division before any further services can take place. I certify that the above is true and correct and that I will comply wit all applicable codes and ordinances of the City of anfory, Florida Sanford Fire Prevention Division Applicant's Signature NOTICE OF COMMENCEMENT Permit No. Tax Folio No. State of Florida County of Seminole Y cz:) o. The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance Ath Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. � Go c� `- 1. Description of property: (legal description of the property and street address if available) T 2. General description of improvement: 3. Owner information a. Name and address b. Interest in property ' c. Name and address of fee simple titleholder (if other than Owner) 4Cvb) Contractor a. Name and address qq 1A � b. Phone number 3 5. Surety a. Name and address b. Phone number c. Amount of bond 6. Lender a. Nam.- and address AV Fax number �. i D�Ri1F1ED r��.a crt .n ett'(ANNt ►. - ..nrrYn Fax number b. Phone number Fax number UAl 1 " — 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as� provided by Section 713.13(1)(a)7., Florida Statutes: a. Name and address b. Phone number Fax number 8. In addition to himself or herself, Owner designates fUl1l to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. w a. Phone number Fax number 9. Expiration date of notice of commencement (the expiration date is 1 year from the date a or m unless a different date is specified) Signature of Own Sworn to (or affirm rme and subscribed before me this day of , 20 O/ , by Personally Known OR Produced Identification Type of Identification Producm—z: �o7a7C7 '7 0 Signature of otary rublic, State of Florida Commissl, Expires: Sharon K Snead * * My Commission CC908001 y � Expires March 25, 2004 hnr� .n rH15 INST P ' A,RfD BY: NAME r9 �1 71 ..1 f. CITY OF SANFORD, FLORIDA PERMIT NO. 01 -1'23S DATE (D Asvo / THE UNDERSIGNED HEREB`( PLIES FOR A PERMIT TO INSTALL THE FOLLOWING H.A.R.V. MECHANICAL EQUIPMENT: OWNER'S NAME-S/MQrJ LZ4JA ADDRESS OF JOB c) (—)wx— MECHANICAL CONTR. KJ. 6J, (fPY Alc641oi1es6l _ RESIDENTIAL COMMERCIAL f Subject to rules and regulations of Sanford mechanical code. NATURE OF WORK Number AMOUNT FUEL MOTOR H.P. B.T.U. INPUT OUTPUT 1 II 1 VALUATION APPLICATION FEE I I I / e'. I . - TOTAL. A _I I Y i l) 1 -__ X/ / Mast4r Mechanical NO. �./►1G — �0�7/ POWER OF ATTORNEY Date: JUNE 15, 2001 I hereby, name and appoint DANIEL N. ALVAREZ of W.W. Gay Mechanical Contractor, Inc. to be my lawful attorney in fact to act for me and apply to the CITY OF SANFORD Building Department for a MECHANICAL permit for work to be performed at a location described as: Section Township Range Lot Block Subdivision SEMINOLE TOWNE CENTER THE GOLD RING (Address of Job) RAMESH BAJAJ (Owner of.Property and Address) and to sign my name and do all things nece.s.sary.to this appointment. W. W. Gay Type or Print Name,.pf Certi(i eei �Contractor am re of Certified or The foregoing instrument was acknowledged before me this 06 / 15 /01 by W. W. Gay who is personally known to me and who did take oath. State'Oof Florida County of Seminole ,%11111,sLouise M. Neyrinek 3 a`tioA�•.p�'. Commission # CC 787354Commission # CC 787354 Expires NOV. 16, 2002 BONDED THRU LOUISE M. NEY�� ATLANTIC BONDING CO., INC. (Notary) My Commission Expires: NOVEMBER 16, 2002 1/92 Wpforms\a:\pwrattrnyform r CITY OF SANFORD, FLORIDA PERMIT NO- DATE THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO INSTALL THE FOL- LOWING PLUMBING WORK: OWNER'S NAME S�` ��"� P"Al7" ` kA- -w &J-4 ADDRESS OF JOB t..� LAJ Ei �- PLUMBING CONTR. —_ Res. _ Comm. Subject fo rules and regulations of Sanford plumbing code. Residential: I Number Amount Alteration, Addition, Repair New Residential: One Water Closet I _ I Additional Water Closet Commercial: Fix res. loor Drain, Trap -- Sewerr - Water Piping Gas Piping Factory -built housing I Mobile Home Application Fee ' Minimum Commercial Permit: $25. oo .. n Total aster o �9 POWER OF ATTORNEY Date: ,TUNE 15, 2001 I hereby, name and appoint DANIEL N. ALVAREZ of W W Gay Mechanical Contractor, Inc. to be my lawful attorney in fact to act for me and apply to the CITY OF SANFORD Building Department for a PLUMBING permit for work to be performed at a location described as: Section Township Range Lot Block Subdivision SEMINOLE TOWNE CENTER THE GOLD RING (Address of Job) RAMESH BAJAJ (Owner of Property and Address) and to sign my name and do all things necessary to this appointment. W. W. Gay Type or Print Name of/lCeytified Contractor Sic atureof CertifeContractor The foregoing instrument was acknowledged before me this 06 / 15/01 by W. W. Gay - who. -is personally known to me and who did take oath. State of Florida County of SEMINOLE Commission # CC 787354 c (Notary) My Commission Expires: NOVEMBER 16, 2002 1/92 Wpforms\a:\pwrattrnyform Louise M. Neyrinck -Commission # CC 787354 rxnires NOV. 16, 2002 ".^E9 THHU INC. 9,712 S. W: 1st. Place I.C.M.S., Inc. Gainesville, 0 32607 cbc 032 y f (352) 332-9901 (352) 332-9903 fax May 15, 2001 City of Sanford Building and Zoning 300 North Park Avenue Sanford, Fl 32771 TO WHOM IT MAY CONCERN: This letter is to notify you of my consent and authorization for Edward Keith Lemmon, to exercise the rights and privileges assigned to the State Certified Building Contractors License # CBC032101 which I currently hold. For your kind attention to this matter, I remain. Yours truly, Steven Robert Winter I hereby acknowledge that the statements contained in the foregoing letter are true and correct. Sworn and subscribed before me this 15th day of May, 2001. My commission expires: JOANN L. COALSON .� �P� MY COMMISSION # CC 962287 y�Of ile` EXPIRES: Aug 11, 2003 1-ND-MOTARY Fla. Notary Servlos & Bonding Co. kt%- 15. Zoo CITY OF SA`NFORD ELECTRICAL PERMIT APPLICATION Permit Number: J Date: �i Q The undersigned hereby applies for a permit to install the following electrical: Owner's Name: Address of Job: 2 �7 Z SUM _71 6J N CAA/ rX TC lVe4141 Electrical Contractor: tr,47 r �ZS Residential: Non -Residential: V Number Amount Addition, Alteration, Repair (Residential & Non-Residential)zo New Residential: AMP Service New Commercial: AMP Service Change of Service: From AMP Service to AMP Service Manufactured Building Other: Description of Work: %Zd 6r- Application Fee: $10.00 TOTAL DUE: -2)0 By Signing this application I am stating that I am in compliance with City of Sanford Electrical Code. cant's Signatu C_A 00/!�1 7 State License Num CITY OF SANFORD PERMIT APPLICATION ' T Permit No.: 010 ✓ Date: Job Address: Seminole. ��rL�_ GeAcN, :SAn+ b91 E10,Z'+t, an?l Parcel No.: �k-OgIR Sp E an ra., (Attach Proof of Ownership & Legal Description) Description of Work: Type of Construction: Valuation of Work: $ Number of Stories: Owner: Dwelling Units: Zoning Flood Zone: Commercial Industrial Total Square Footage: 13GJ i�' 1v v Address: tit Ol as IIJe�. tkalk City: , si re State: s,� Zip: �176 Phone No.: Fax No.: Contractor: Address: 1 .� LA�\ City: Cyi-ma ;11 rZ State: Zip: _ Z( State License No.: CA&- o39.1 M Phone No.: Fax No.: 3AQ 33a gg63 Contact Person: V-e Phone No.: 2JQ 9?,5R 0 Title Holder (If other than Owner): U Address: Bonding Company: WA Address: Mortgage Lender: Address: Architect: 130 1A D6a-Y\ Phone No.: 3o6 3 Vb �z]y,b Address: Cift�> l�I'1�. ;cr„"i;),J�) Q�t— Fax No.: 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. 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 la -/ e'�P; Signature of Owner/Agent Date Signat PAIN-N E�L" a A-�q-J- Print OwnedAgent's Na}ne of N/ota' -State of Florida Date 0, P ; sron K Snead *My Commission CC908001 A Expires March 25, 2004 requirements of Florida Lien Law, FS 713. .940 Contractor/Agent Date Print Contractor/Agent's Name L A, �Wz�x � 4 elz ® D� SignafCre of No -State of Florida Date Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or _LiProduced ID ��t , l�e7�0 `7�.S�I dS/�c L.--Produced ID rpC. SSa�?r3Js;d APPLICATION APPROVED BY: Date: Special Conditions: CITY OF•'SA14 ORD, FLORIDA APPLICATION FOR THE DEMOLITION AND REMOVAL OF BUILDINGS AND STRUCTURES R. 9 'O U 7 'd 0 P a ac 0 C a 3 �. 0 E Z Z > A 14 H ro w >4 a 0 N O O 4) >1 z a H PERMIT ADDRESS Ar)a C�v�jcIL PERMIT NUMBER6 I-" I v TOTAL CONTRACT PRICE OF DEMOLITION 1-4 TOTAL SQUARE FT. TAX PARCEL NUMBER OWNER �AMeS�, ( ,, C,J PHONE NUMBER ADDRESS ^Z J ar Np CITY r STATE yl, ZIP j To CONTRACTOR C S C - ADDRESS 5l_ l6 C CITY l�v�,y�e�J���2 STATE PHONE NUMBER 35a 33a Ci90/ --��-- ST. LICENSE NUMBER t✓�jC (0)OL .dC, ZIP _3a(on0 TYPE OF STRUCTURE TO BE DEMOLISHED: FRAME CONCRETE BLOCK PREVIOUS USE OF BUILDING OR STRUCTURE PROPOSED USE OF THE SITE STEEL OTHER GAS COMPANY DISCONNECT NUMBER (IF APPLICABLE) GAS COMPANY PERSONNEL ISSUING NUMBER NOTE: GAS COMPANY SECTION MUST BE COMPLETED BEFORE DEMOLITION PERMIT WILL BE ISSUED. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER THE WORK IS COMMENCED. 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. THE NAMED CONTRACTOR/OWNER BUILDER TO WHOM THE PERMIT IS ISSUED SHALL HAVE THE RESPONSIBILITY FOR SUPERVISION, DIRECTION, MANAGEMENT, AND CONTROL OF THE CONSTRUCTION ACTIVITIES ON THE PROJECT FOR WHICH THE BUILDING PERMIT WAS ISSUED. OWNER'S AFFIDAVIT: I CERTIFY THAT ALL THE FOREGOING INFORMATION IS ACCURATE AND THAT ALL WORK WILL BE DONE IN COMPLIANCE WITH ALL APPLICABLE LAWS REGULATING CONSTRUCTION AND ZONING. A COPY OF THE RECORDED COPY OF THE NOTICE OF COMMENCEMENT WILL BE POSTED ON THE JOB SITE WITH PERMITS NO LATER THAN SEVEN (7) DAYS AFTER THE PERMIT HAS BEEN ISSUED. FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR THE IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. ASBESTOS NOTIFICATION STATEMENT (SEC. 553.79(11), FL STATUTES) FOR FACILITIES OTHER THAN SINGLE FAMILY OR DUPLEX HOUSING. I HEREBY AFFIRM THAT I HAVE COMPLIED WITH THE PROVISIONS OF SECTION 455-302, FL STATUTES, AND HAVE NOTIFIED THE DEPARTMENT OF ENVIRONMENTAL REGULATION OF MY INTENTION TO REMOVE ASBESTOS, IF PPLICABLE. 5- 30- 0/ SIGNATUR OF O NER RNT & DATE IGNATURE OF CONTRACTOR & DATE j&) i (NT GNATURE OF)NOTAR 'DATE (OFFI S ) /nw OVo,017 OR PRINXO JCTOR'S NAME .3-0-�)1 :GNATU F NOTAIRY & DATE (dPtICIAL SEAL) °OY";�,•,,, Mary L. Muse Commission # CC 851644 .r.: Expires Aug. 4, 2003 �`�'••'o %> ••..••' - Bonded Thru Atlantic Bonding Co., Inc. APPLICATION APPROVED BY ~ DATE FEES: BUILDING APPL VON OTHER PERMIT VALIDATION: CHECK CASH DATE BY PINK (COUNTY TAX OFFICE) ORIGINAL (BUILDING) YELLOW (CUSTOMER) LC M.S., Inc. cbc 032101 May 15, 2001 City of Sanford Building and Zoning 300 North Park Avenue Sanford, FI 32771 TO WHOM IT MAY CONCERN: 9712;.S W. 1 st. iPlace `Gainesville, F7 32607 (352) 332-990T (352} 332=9903 fax ; This letter is to notify you of my consent and authorization for Edward Keith Lemmon, to exercise the rights and privileges assigned to the State Certified Building Contractors License # CBC032101 which I currently hold. For your kind attention to this matter, I remain. Yours truly, '1� e4 Steven Robert Winter I hereby acknowledge that the statements contained in the foregoing letter are true and correct. Sworn and subscribed before me this 15th day of May, 2001. My commission expires: JOANN L. COAiSON MY COMMISSION * CC 862287 01 ilv" EXPIRES: Aug 11, 2003 1 8063 NOTANY Fla Notary Ser.1 d 8ondnp Co. A -ool 6� Permit No. State of Florida County of Seminole NOTICE OF COM ENCEMENT Tax Folio No. o CO CD The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance Ath �CDn Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. cry 0 1. Description of property: (legal descri lion of the property and street address if available)CM - - 2. General description of improvement: Ev. ry- 3. Owner information a. Name and address b. Interest in property ' c. Name and address of fee, simple titleholder (if.other than Owner) 4. Contractor a. Name and address qq la '%;� i b. Phone number -3 5. Surety a. Name and address b. Phone number _ c. Amount of bond 6. Lender a. Nama and address b. Phone number - C)r'l Faxnumber a501 33R g9(N3 IN) DI,RTIFIED COPS �� � Fax number Fax number 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes: a a. Name and address _li\ b. Phone number Fax number In addition to himself or herself, Owner designates N)-A to receive a copy of the Lienor's Notice as provided in Section 713:13(1 j(b), Florida Statutes. a. Phone number Fax number x 9. Expiration date of notice of commencement (the expiration date is I year from the date VZun less adifferent date is specified) -T Sinature of Own{ _ I 6��T Sworn to (or affirme and subscribed before me this day of , 20 O j , by /77kw14 I Personally Known Type of Identification P j,,, OR Produced Identification !-- Signature JfA otary blic, State of Florida CommissIO6 Expires: 'j , .,y Sharon K Snead * * My Commission CC908001 o,, �� �� f Expires March 25, 2004 rHIS w45TUA-- P RRED BY: NAME y ADDR. DEVELOPMENT FEE WORKSHEET CITY OF SANFORD UTILITY - ADMIN. P. 0. BOX 1788 SANFORD, FL 32772-1788 Project Name: CAL;) /It Date: -54,q Owner/Contact Person: Phone: Address: �� _' r.c ,...,� i N;f� 2.2 \ Type of Development: 1) RESIDENTIAL Type of Units (single family or multi -family): Total Number of Units: Type of Utility Connection (individual connections or central water meter & common sewer tap): Water Meter Size (3/4", 1", 2", etc.): REMARKS: 2) NON-RESIDENTIAL Type of Units (commercial, industrial, etc.): /`7� Total Number of Buildings: Number of Fixture Units (each building): Type of Utility Connection (individual connections or central water meter & common sewer tap): Water Meter Size (3/4" 1", 2", etc.) REMARKS: CONNECTION FEE CALCULATION: /VO /� ,O !1 / ` 7/c, W L PL yC Name - Signature - Date. Ic'-o%j REVISED �a�9� J SANFORD FIRE DEPARTMENT FIRE PREVENTION DIVISION 300 N. Park Ave., Sanford, FI.32771 / P. O. Box 1788, Sanford, FI.32772 (407) 302-2520 FAX (407) 330-5677Pager (407) 918-039 Inspector Timothy Robles Plans Review Sheet Date: May 23, 2001 Business Address: 272 Towne Center Occ. Ch. 24 Mercantile Business Name: Gold King Ph. () UNK Contractor: I.C.M.S. INC. Ph. (352) 332-9903 Reviewed [ ] Reviewed with comment [ X ] Rejected [ ] Reviewed by: Timothy Robles, Fire Inspector Comment: Plans reviewed as Mercantile Occupancy. FD reserves right to require applicable code requirements if occupancy use changes. Sprinkler plans to be submitted for review, permitting, and inspections 1.1 Application — Interior renovation 1.2 Mixed — N/A 1.3 Special Definitions — N/N 1.4 Classification of Occupancy — Mercantile 1.5 Classification of Hazard of Contents — Ordinary 1.6 Minimum Construction — N/R 2.2 Means of Egress Components — O.K. 2.3 Capacity of Egress — O.K. 2.4 Number of Exits — O.K. 2.5 Arrangement of Egress — O.K., will field verify 2.6 Travel Distance — O.K. 2.7 Discharge from Exits — O.K., will field verify 2.8 Illumination of Means of Egress — O.K.; will field verify 2.9 Emergency Lighting — O.K.; will field verify SANFORD FIRE DEPARTMENT FIRE PREVENTION DIVISION 300 N. Park Ave., Sanford, Fl. 32771 / P. O. Box 1788, Sanford, Fl. 32772 (407) 302-2520 FAX (407) 330-5677Pager (407) 918-039 Inspector Timothy Robles 2.10 Marking of Means of Egress — O.K.; will field verify 2.11 Special Features — O.K. 3.1 Protection of Vertical Openings — N/N 3.2 Protection from Hazards — N/N 3.3 Interior Finish — Class "B" 3.4 Detection, Alarm and Communications Systems 3.5 Extinguishing Requirements — as per NFPA 10; Two Q fire extinguishers required see sheet E-1 3.6 Corridors — N/A - 4 Special Provisions - 5 Building Services 5.1 Utilities — as per LSC 7-1 5.2 HVAC — as per LSC 7-2 5.3 Elevators, Escalators, Conveyors (4A-47) — N/A 5.4 Rubbish Chutes, Incinerators, and Laundry Chutes — N/A Sanford City Code — Chapter 9 Fire Sprinklers: existing Monitoring: Other: NFPA 1 3-5.1 Fire Lanes 3-6.1 Key Box 3-7.1 Bldg. Address Number Posted and Legible — P A CITY OF SANFORD PERMIT APPLICATION-�� Permit No.: d 1 I J :T Job Address:Q,_1 �L .,01 x-:T'o LA ,L-Ue_ -)VA; IC H 0 �{ A Parcel No.: (Attach Proof of Ownership & Legal Description) Description of Work: t- ! me Sep nit Its Type of Construction: Flood Zone: Valuation of Work: $ a S 00 ' °' Occupancy Type: Residential Commercial Industrial Number of Stories: Number of Dwelling Units: Zoning: Total Square Footage: Owner: Address: City: Phone No.: State: Fax No.: Zip: Contractor: Address: ):`0 City: _ X �k'til�•.�' S� ;I►z State: r I Zip: 3 ;,t.0 State License No.: C\ 31 0 0 0 15 U Phone No.: 3 S Zk- - 3 b d- O 31 Fax No.: 3S7-- 11%^ 14S Contact Person: —?-, 1, CA-•uz .� P,3vto©Y--, Phone No._5 S -1, 3`so — 0311 Title Holder (If other than Owner): Address: Bonding Company: Address: Mortgage Lender: Address: Architect: Address: Phone No.: Fax No.: 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. 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. _!S, 01 Signature of Owner/Agent Date Signature of Contractor/Agent Date Print Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or _ Produced ID APPLICATION APPROVED BY: j?_, c vA.A boo, Print Contractor/Agent's Name / ) t l�1 G C'/ Signature of Notary t_a _ Date ANN M. JOHNSON :. MY COMMISSION # CC 921808 v s EXPIRES: March 23, 2004 Bonded Thm Budget Notary Services Con ctor/Agent is Personally Known to Me or Produced ID 1 j 450 (c V-3810 Date: —J / — Special Conditions: ,rrir G AYW.W. GAY FIRE & INTEGRATED SYSTEMS, INC. 522 STOCKTON STREET - JACKSONVILLE, FL 32204 - PHONE 904-387-7973 - wwwgfp@eanhlink.net June 6, 2001 Attention: Building Department City of Sanford P.O. BOX 1788 Sanford, Florida 32772 VIA FACSIMILE: (407) 330-5677 Dear Sir or Madam: The following employee is authorized to pull permits for our company under my State of Florida License Number EC-AO01417 (copy attached): Bryan Williams If you should have any questions, please contact me at (904) 387-7973. Andrzej Ratajczyk, Vicey6sident W. W. Gay Fire & Int gr ed Systems, Inc. AWcsn cc: CAMy Documents\Word\FORMS\Permit Authorization Letters\Permit-Auth-AR-Sanford.doc STATE OF FLORIDA COUNTY OF DUVAL Sworn to (or affirmed) and subscribed before me this 6`h day of June 2001, by Andrzej Ratajczyk. , CAROLINE SUE NEELEY 77 NOTARY PUBLIC, STATE OF FLORIDA a.: ac My commission expires Nov. 3, 2001 Commission No. CC693551 Personally Known or Produced Identification (Type of Identification Produced_ Fire Protection Systems - Fabrication - Alarm Systems - FM-200 - Tele/Data Communications - Access Controls/CCTV,, Fiber Optics - AN Systems Jun-05-01 O8:01A W. W. Gay Fire Protection 904 381 7660 P.O2 A' Y VVX GAY FIRE & INTEGRATED SYSTEMS, INC. 522 STOCKTON STREET • JACKSONVILLE, FL 32204 • PHONE 904.387-7973 • wwwgf @eanhlirik.net June 4, 2001 Attention_ Building Ueperriment Sanford, Florida VIA FACSIMII.F.: (407) 330 _5677 Dear Sir or Madam: i hereby authorize the following employee of W. W (jai, Nre & Integraie(I Systems, Inc. to pull permits under my State of Florida Ccrtificate of Competency License Number 766937000190 (copy attached). • Richard Bloom If you should have any questions, please contact me at (904) 387-7973, Ext 157 Sincerel Dennis M. Bishop Vice President W. W. (art., Pire & Inlegrated Systems, Inc. DMH;c%n Filelomic W: C My IAxau etit-Tauat Amthvrization - 0H.dcic STATE OF FLORIDA COUP OF DUVAi. Project: Gold King Jewelry 272 Seminole Town Circle Suite H04A Sworn to (or affirmed) and subscribed tidiorc ine (his 4 ' day of June l by Okwinis M, Bishop ,e, ,N KIM r Mr4d" lYT � *>f RAy Commission CC691164 ' °^►.,,,W ins Nowmba Z9. 2003 - Personally Known . X ._ or Produced Identification (Type of Identification Produced — Fire Protection Systems - Fabrication - Alarm Systems • FM-200 • TelelData Communications • Access Controls/CCTV • Fiber Optics • AIV Systems