HomeMy WebLinkAbout1290 Red Cleveland Blvd 03-2132 fire sprinklersCITY OF SANFORD) PEA'MI'I' APPLICATION
Permit No.:
Job Address: Rff-
Permit Type Building
Description of Work: 0k
Date: (C>,
Electrical Mechanical Plumbing
Additional Infformation for Electrical & Plumbing Permits
Electrical: _Addition/Alteration ,Change, of Service Temporary Pole _New AMP Service (# of AMPS,
Plum bin g/Residentia1: Addition/Alteration New Construction One Closet Plus
( Additional)
Plumbing/Commercial: Number of Fixtures Number of Water & Sewer Drainage Lines Number of Gas Lines
Occupancy Type: _Residential —Commercial Industrial Total S Ft-
- 9 g: Value of Work: S.
Type of Construction: Flood Zone: Number of Stories: Number of Dwelling Units:
Parcel No.: —�—
(.Attach Proof of Ownership & Legal Description)
Owner/Address/Phone: -
Contractor/Address/Phone: P-- i 9 1
State License Number; we °,�
Contact Person: �� Phone & Fax Number: ", f
Title Holder (If other than Owner):
Address:
Bonding Company:
Address:
Mortgage Lender;
Address:
Architect/Engineer
Address:
Phone No.:
Fax No.,,
77
Application is herebymade to obtain apermit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance o P f 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 req irements of Florida Lien Law, FS 713.
Signature of Owner/Agent Date
Signature of Con act r gent pate
Print Owner/Agent's Name Prtt Contractor/A n 's N in ----
'
f
Signature of Notary -State of Florida )_late -
igriat o . ota l3 f 6f 69ft Date
M COMMISSION # DO 164280
�. �XaIR�S';1Vtr�riti)eri�,"2t'�6
y9R'� Bonded Thru Budgef Notary 440
EXPIRES: Novdinuer 12, 2006
ATFOF F�oBonded Thru E AGut Notary, Services
Owner/Agent is Personally Known to Me or Contractor/Agent is _ P nally Known to Me or
T Produced ID _ Produced ID -- —
/%PPLICATIOI APPROVED BY: �� c
- _ Date:
Special, Conditions:
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MATIONM NO. 186A-IBX2401115