1125 Rinehart Rd 06-1338 Fire alarmJob Address:
Description of Work:
Ilistoric District:
Zoning:
FdLC,*EIVED
CI'f Y OF SANFORq i"RMCC Al'1'LICATION
Date: '
D(r FEB .� O Z00G ,
Valuc of Work:
Perntit Type: Building Electrical Mechanical Plumbing Fire Spriukler/Alarut -/In-- fool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service 'Temporary Pole _
Mechanical: Residential Non -Residential Replacement New (Duct Layout S, Energy We. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines It of Gas Lines
Plumbing/New Residential: It of Water Closets Plumbing Repair — Residential or Commercial
YST 'm
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: It of Stories: It of Dwelling Units: Flood Zone: (FEMA form required for other than <Y)
Parcel #:
Owners Name & Address:
(Attach Proof of Ownership & Lcgitl Description)
Phone:
Contractor Name & Address: lFi7f iC d?_Ci�l_ i �V�r.rT�MS L-�'VQ ,tt)
'= r r T tr- State, License Number:
Phone &Fax: Contact I'crsou: % = y X1C-Mt-(. I Phone:
Bouding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: 1'Iwuc:
Address: Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 ccrtily 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 haws regulating construction in this jurisdiction. I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, IIEATE16, "YANKS, and
AIR CON DYYION EKS, etc.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be clone in compliance with all 'applicable laws regulating
construction and zoning. WARNING TO OWNER: YOUR FAIL,URE'YO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WHII YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMNIFNCEMENT.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this properly that may be round ill the public records or
this county, and there may be additional permits required from other governmental entities such as water management districts, slate agencies, or federal agencies.
Acceptance of permit is verification that 1 will notify the owner of the property of the requiOfFlorida Licn Law, PS 713. res ri
Signature of Owner/Agent Date i� nature ok ,ontractor/Agent Date
Print Owner/Agent's Name Prutt Contractor/Agent's Name
Signature of Notary -Slate of Florida Date Si4uture o " otary-State of Florida to il, Jacqueline S Court
a My Commission OD152558
~'por►tie°�Q Expires October25, 2006
Owner/Agent is Personally Known to Me or
ProducedID
APPLICATION APPROVED BY: Bldg: `. \ 1 11 'Zoning:
(lnMal'' Da c)
Special Conditions:
Contractor/Agent is/-- Personally Known to Me or
Produced ID
(Initial & Date)
Utilities:
(Initial & Date)
r" 1
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