HomeMy WebLinkAbout241 Towne Center Blvd 06-3112 fire alarmdo- I 6,
Pvrtuit # :
Job Address: -2 4 1—�J q W/4 0-
Descriptiou #)f work.: :JTA Y 0-
CITY OFSANFORD PERNII'.' APPLICATION
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re— cdurt"
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Date: & - ;t 5 — C) RECEIVED
Z006
Historic District: i
"Zoning: ___.-_ Value of Work: S '/0 13-7, 00
Per,"itType; Building Electrical Mechanical ___ Plumbing Fire Sprinkler/Alarm --X-- pool
FiLctrical: New Service - # of AMPS Addition/Alteration ot'Service'
I'vinpurwf Pole
Mechanical: Residtaitial-- Non -Residential Replacement --.- New y
(DtictLayout bnerg Catc. Reylired)
Flurnbing/ New Commercial: # of Fixtures if of Water & Sewer Lines---- # of'Gas Lines
flunibing/New Residential: # of Water Closets ---. _ plufilbing Repair - or coninlefy';ial
Occupaaey Type: Residential Conirnercial industrial Total Square Footage:
C'u"'ifucC100 Type: of Stories: ---- 4 of Dwelling Units: Flood h)ne: (FENIA form required for other tb4n X)
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IN
Passel fi: 7 t
0 (Attach Proof Of Nler'hlLegat Description)
O"wr5 Name ev Address:
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Contractor Name & Addrew—A J) 1
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Addreis:
Address:
itrvhltect/EagIoC'ar: ------
Addr"r,
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Z-90 rLd I 1i aq 161 kuo r
Phone-
2 ik4:�Je v e-
04 Sv I Em-- q
- State License ti 141fib-n j
Contact Person:
Application is (Wrby made to obtain a pennit to do the work and installations as indicated. I certify that no work or pwalWion hdi Qomracriced prior to the
i6',juanw of a. pt-nnit and thzt all work will b4 performed to meet scandards of all laws regulating construction in tealsjurisdictiwi- f understand rhat a sepaiatc
ennit must b,�. wcumd for F p LFcTRICAL WORK, ILUIOWNG, SIGNS, WELLS, FOOLS, FURNACES, IJOILRRI3, HEATERS, TANKS, and
AIR CONDITIONERS, etc,
OWNER'S EFRIA T: I certify that all ofthe foregoing information i� accurate and that all - in 1 (n 'e'.vith all applicable law; regulating
—Z� . YL_ work will be dow, pliarv,
construction arid zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CONIM-ENC91EVIT MAY RESULT IN YOUR PAYING
'TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDL4X OR AN'
A TrI1()RI'iE 'y BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NO f ' In addition to the requirements of this perniit, there may be additional restrictions applicable to this proper ), that may be found in the public re,-ordi
C k;
this county, and there may be additional permits rquircd from other governmental entities sit h as neater i fnana�;crneljt districts, state agenics' or federal agew
ACCqximceof ptimit it. verification that I will notify the owner Of the properry of the requirements ofhovidj)✓Licn LAW, I/> 7
Signature Of Owner/Agent Date
Print Owner/Agent's Nat-rie
Signature of Notary-Staw of Fk)nda Date
Owner/Agent is —__- Personally Known to Me or
--- Produced 11)
APPLICATION APPROVFD BY:
Liming:
4
(ln - t1- 'Al � hate)
Special Conditions:
Signature oftontractur/Agent Data
<I-
I'- - printcontlac, \gent'sNalq'
Signature of N Dan:
Contractor/Agent is,/,—<— Pet-1-onaliv Known to Me or
Produced ID
Utilili'!S:
(1111hal 8., Date) (Initial &
FD:
(Initi I ate)
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