HomeMy WebLinkAbout1150 E 28 St 05-444 Sprinkler monitoring systemPermit # :
Job Address:
Description of Work:
Historic District:
CITY OF SAN,>?ORD PERMIT APPLICATION
Date:
<+, fS>7t-0 (:)12-9
Zoning: Value of Work:
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm _v Pool
Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical; Residential Non -Residential Replacement New (Duct Layout &Energy Cale. 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 X)
Parcel #: (A(tach Proof of Ownership & Legal Description)
Owners Name & Address:
_ Phone:
Contractor Name & Address:
�jsJ�jt?�U) (='c j2 7 9 ,c) ) State License Number:
Phone:
Plrone & Fax: �•7 ._ 3 �''r � � C �ac P r'on: <
Bonding Company:
Address:
Mortgage Lender: OCT n j -
Address: / L•
Architect/Engineer: Phone:
Address: r�rr T Fax: _
Application is hereby made to obtain a pennit to do the work and installa otts as ljdj" Tted'l Iti er if I'1�„fit no work or installation has commenced prior to the
issuance of a pennit and that all work will be performed to meet standards yes
s r gulating cons ruction in this jurisdiction. I understand that a separate
pennit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, IIEATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAV 1'1': 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 TQ OBTAIN FINANCING, CONSULT WI t[ YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements or this pennit, 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 $uoh a V,ter rnanagerncat districts, slate agencies, or federal agencies.
Acceptance of pennit is verification that 1 will notify the owner of the property of the required ;f� 'orida7'',FS 713.
P ��--- /d
Signature of Owner/Agent Date Signatu of Contractor/Agent Date
W0Ids M6C'
Print Owner/Agent's Name
Signature of Notary -State or Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
Print Contractor/Agent's Name
S'igrrature of Notary -Slate o Florida Date
DEBBIE BLANTON
ContraC or MY WMMI�'ifg�10� # DD I8 91
_ Pr dnc — �xPYFi °St':`F�bruary 6��c or
ff jj 1-800-3-NOTA rY otwy iscoun --CC')
APPROVED BY: Bld S. t l � � � Zoning: Utilities-� FD: �—.{�p - �•r �
APPLICATION APPRO : g
(Initial & Date) (initial &Date) (Initial & Date) (Initial & Date) .
Special Conditions:
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