HomeMy WebLinkAbout300 Northstar Ct 06-683 Fire sprinklersCITY OF SAMIT APPLICATION NFORD PER
RECEIVED
Permit # :� `� �? '�) ., `' U r
Date: � �vo�
Job Address: c� iJ /J U Lin 1 1 A -A 6,m m I—
Description of Work: MOD/ gy •t a f1 wv r' Z'I Jl / S/I/t / fvlC i� Sti C l ��
Historic District: Zoning: Value of Work: $ .3.Ua� ___._._,•_. _
Permit Type: Building Electrical _ Mechanical Plumbing �re Sprinkle Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service 'Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cald, Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Conunciuial _
Occupancy Type: Residential Commercial Industrial fotaFSquare Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
msia�
Parcel ff: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: rn A/1M ( G[ % Med l7'K/ U 6 .- ?A
3Ut) Na4?1 fTb- CdvM r Phone:
Contractor Name & Address: jo-4 W pint ) tome )y--j
L )kl V f N l ('M ct/k CA( /ar4-07 State License Number: �d 7 % eve)
Phone & Fax:.. 40) 79 Contact Person: �rJ1/ �J� `ti�Ca Phone, ail `f ^ 7P? — /,)j—
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has caitmnenoeel 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 utid,tSva¢id ti;r>rt a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TAI KZ 3, 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 ali applicable. inves rrgulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN Y f. 0A. PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LEN[Azlk gilt. &N
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 mquirouncrittsoff,Florida Lien Law, FS 713.oe
Signature of Owner/Agent Date Signature of Contractor A gent Dale
Print Owner/Agent's Name
Signature of Notary -State of Florida
Owner/Agent is — Personally Known to Me or
Produced ID
APPLICATION APPROVED BY
Special Conditions:
Date
Bldg:. Zoning:
Initial & Date)
Print Contractor/Agent's Name
Signature of Notkry�S4tte of Florida
Contractor/Agent is Personally k
Produced [D
Utilities•
(Initial & Date) (Initial & Date)
MARY LANDER
Notary Public - State of Florida
MY COMMK{on Expires Jan 2, 2009
Commission # DD 366046
Bonded y Natlonai NotaryAssn.
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