HomeMy WebLinkAbout307A E 1St St 04-622 fire systemale�t�'�
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C',TY OF SANF(?"D PERMIT APPLICATION
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Permit # Date:
: '� V�L---'' $� q�
Job Address: l'� 6 7 f 1
Description of Work:���`/a� aLr i/a��
Historic District: Zoning: Value of Work: $�
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than %)
Parcet#: °V'J__
Owners Name & A dress: F a3 / y s U
(Attach Proof of Ownership & Legal Description)
Phone:
Contractor Name & Address: 2_30 1 W.
State Licen,-.e Number: _ d
Phone & Fax: 0 , MM)E3W-Wontact Person: Phone: C l3 ZO 1
Bonding C
Address:
Mortgage
Address:
Architect/
Address:
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 constructiot m this }urisdiction. I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUM $t�G SIGNS, WF;;f�I,�S, P�OO�S,LL�gI ACES B4jL5kRS HEATERS, TANKS, and
AIR CONDITIONERS, etc. L� _
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OWNER'S AFFIDAVIT: I certify that all of the foregoing &&&nation is cura end li t�a�l wsorlc wi1J be done. iU co Nance with all applicable laws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO "CORD F NgjlI &t Oq� CRMMEh10EM�_T MAY RESULT IN YOUR
Pf;.1r1F C
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY IF_YOU INE��O T N J)Q CONSULTITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMNIEN q E E P,
NOTICE: In addition to the requirements of this permit there maybe additional restrictions applicable to this property that may be found in the public records of
this county, and there ,may be additional pecnits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of - i /i erification that I will notify the owner of the property of the requirements of Florid Li n Law, FS 713.
Signature of Owner/Agent Data Signature of Contr tor/ _ D to
Print Owner/Agent's Name j Ftnt contractor/ ent's Name
v / Edward M. Lopes j V ( �C4''-7
to c Date Signatu of Notary- rate o Florida Date
Owner/Agent is _ Personally Known to Me or Contractor/Agent is /ersonally Known to Me or
Produced [D
Produced ID C
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APPLICATION APPROVED BY: Blde Zoning: Utilities: FD: s
(Initial & Date) (Initial & Date) (Initial & Date) (Init ail
Special Conditions:
eA(- OTHY L. ROBLES
MY COMMISSION N CC 905915
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EXPIRES: FeSruary 22, 2004
o ^^^ded Thru Budget Notary Services
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Date: a
"WED PLANS REVIE
CRY OF SANFORD
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