HomeMy WebLinkAbout106 Brierwood Dr - M18-002683 - HVACL.i3.08
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:! 8- a (P8 3
3ao
Documented
Construction Value: S , Job
Address: 1 U ?)y j -e i- >rind f Historic District: Yes No Parcel
ID: ?3- - -5M - - 2w Residential Commercial Type
of Work: New Addition Alteration Repair. Demo Change of Use Move Description
of Work: Plan
Review Contact Person: C]
Title:
Phone:
bj-S,ZZ-2fe(e,'_ Fa - EmaiLISQ Sr ( P i c' I f . c,", Property
Owner Information ' I
Name
lL I'a'M a nl P_ I LSP_I I Phonc:401- 2S - Street: /)
12f r N--'-A Dr Resident of.property? : City, State
Zip: r Contractor Information
Name - Phone:
4401- (o S' Street: t"('
k'i 1 cis CA _KI Fax: Lh)l - -.2, 3-a' City, State
Zip: ,caCl EL , -11 ` State License No.: C AO_ () 1114 4 v Name: Street: City,
St,
Zip:
Bonding Company: Address:
ArchitedlEngineer Information
Phone:
Fax: E-
mail:
Mortgage
Lender: Address:
WARNING TO
OWNER:
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED
ON TIRE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR 'AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 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 construction in this jurisdiction.
1 understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers, heaters,
tanks, and air conditioners, etc. FBC 105.3
Shall be inscribed with lire date of application and the code in effect as of that date: 5'" Edition (2014) Florida Building Code Revised: June 30,
2015 Permit Application
y01_ "-: In addilioa to the requirements of this persnit, there may be additional tcstrictions applirnbic to this property this muy hefoundinthepublicrccorrkofthiscounty, and there may be additional permits required from other governmental enWies such as water
in:ntngement districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property ol'the requirements of Florida Lien Law, FS 713.
The City of Sanford requires payment of a plan review let at the time of permit submittal. A copy of the executed eonauci is required
in order to calculate It plan review charge and will Ix: considered the estimated construction value of the joli at the time of submittal.
The neutral construction value will 6e figured based on the current ICC Valuation fable in etrecl at the time the permifis issued, in
accordance with local ordinance. Should calculated charges figured off the executed contact exceed the actual construction value, cn:di! will be applied to your pcnnii fees when the pennit is issued.
OWNER'S AFFIDAVIT: 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.
4~
Signature nt•owncr/At;e111 gate Sign cof ontraetor/Ageni ODIC
s• 1
P!ml Uwnw/Agrrn't NDIUD Prtnt COntra4 r/ACerllfa Numc
Florida Date rMW YJotarrFa/blle+ FWfldW. My
Comm. Expires Jan 26.2018INowI - Commisslon # FF 076322 , Owner/
Agent is Personally Known to Me or Produced
ID Type of ID Contractor/
Agent is.- \12-Personally, Known to Me or Produced
ID Typc-of ID t t,
BELOW
IS F012 OFFICE USE ONLY Permits
Required: Building Electrical Mechanical Plumbing Gas Roof Construction
Type: Occupancy Use: Flood Zone: Total
Sq Ft of Bldg: Min. Occupancy Load: a of Stories: New
Construction: Electric - It of Amps Plumbing - # of Fixtures Fire
Sprinkler Permit: Yes No it of -Heads _ . _ _ Fire Alarm Permit: Yes No APPROVALS:
ZONING: UTILITIES: WASTEWATER: ENGINEERING:
COMMENTS:
FIRE,.
BUILDING: Re.• .-
A. tta:; ?'I. 20; 5 PC. mii Applicatiun
ot,rr ralctsl v1Gw..2J-1y-.3V-JVL-VI_VV-VL1V nttp://parceiaetail.scpatl.org/Parcellletaillnto.aspx?PID=33193050....
M Properly Record -Card
Parcel: 33.19-30-502-0000-0220
asr.raaoo om' nnnor Property Address: 106 BRIERWOOD DR SANFORD. FL 32771
Parcel InformaUon
Parcel 33-19-30-502-0000-0220
Owner(s) RUSSELL. NATHANIEL
RUSSELL. ELIZABETH
Property Address 106 BRIERWOOD DR SANFORD. FL 32771
Mailing 106 BRIERWOOD DR SANFORD, FL 32771-
Subdivision Name IDYLLWILDE OF LOCH ARBOR SECTIONS
Tax District St-SANFORD
DOR Use Code 01-SINGLE FAMILY
Exemptions 00-HOMESTEAD(2017)
GIs
Value Summary
2018 Working 2017 Certified
Values Values
Valuation Method Cost/Market Cosl/Market
Number of Buildings 1 1
Depreciated Bldg Value 188,562 177.539
Depreciated EXFT Value 15.291 11,378
Land Value (Market) 45,000 37.500
Land Value Ag
Just/Market Value •• 248.853 226.417
Portability Adj
Save Our Homes Adj 17.681 0
Amendment 1 Adj O
P&G Adj O O
Assessed Value 231,172 226.417
Tax Amount without SOH: $3,523.00
2017 Tax Bill Amount $3,S23.00
Tax Estimator
Save Our Homes Savings: $0.00
Does NOT INCLUDE Non Ad Valorem Assessments
Legal Description
LOT 22 BLOCK C
IDYLLWILDE OF LOCH ARBOR
SEC 5
PB 19 PG 46
Taxes
Taxing Authority Assessment Value Exempt Values Taxable Value
County General Fund 231,172 50.000 181,172
Schools 231,172 25,000 206.172
City Sanford 231.172 50,000 181.172
SJWM(SainlJohns Water Management) 231,172 50.000 181,172
County Bonds 231,172 50.000 181.172
Sales
Description Date Book Page Amount Qualified Vac/Imp
WARRANTY DEED 10/1/2016 0 285.000 Yes Improved
SPECIAL WARRANTY DEED 9/1/2015 8Q5581106141,000 No Improved
CERTIFICATE OF TITLE 6/1/2015 Q>3493 1298 100 No Improved
QUIT CLAIM DEED 11/1/2012 07891 0259 70,000 No Improved
WARRANTY DEED 5/1/2004 Q5334 M 220,000 Yes Improved
WARRANTY DEED 4/1/1995 02903 1 1 135,000 Yes Improved
WARRANTY DEED 1/1/1975 52,900 Yes Improved
Find coatpor me Sda
Land
Method Frontage Depth Units Units Price Land Value
LOT 1 45,000.00 E45,000
Building Information
1 of 2 5/30/2018, 9:51 AM
Page 1
8 )-8 ,1 665
24 Hours - 7 Days a Week 03/01/2018
State Cert CAC032448 r WWW.DELAIR.COM
Elizabeth Russell 407-257-3194 5/30/2018 Rodney Sinkfield
106 Brierwood Dr 407-221-6820 husband Email 407-497-4633
Sanford FL 32771 rsinklield0( delair.com
Description SIZE SEER
Delair AdjustedPrice
Rebate Price
Carrier Comfort 15 PuronO HP 2.5 TON 411115' 4,747 426 4,321
Carrier Limited Factory Warranty: 10 years all functional parts 1 year on labor. UniRosidenlial Use
y
On a 93 Degree Day the inside Temperature can be 78 and on a 30 Degree Day the Temperature will Average 70 Degrees
Enter Optional First Planned' Maintenance Here
Recommended Optional Accessories & Extended Warranty Price Model Included
a. Basic Extended Warranty coverage includes equipment and standard thermostat b. basic
Extended Warranty coverage does NOT include Wifi Thermostat, EAC, Damper Systems, or other accessories unless purchased separtely c. All Extended
Warranties require annual maintenance or coverage is void
Extended Warranties $ Declined
Optional IAQ Enhancements •
Efficiency Agreement $ - Q. - $
H X W X D Heater of Model
AIH 53 7/16 X 21 118 X 221116 — — - — _ CE2601CIO -- 1 - _ FX4DNF031L00 —
COND 32 5116 X 35 X 35 1 I 25HBC530
Honeywell 3htg/2clg Programmable HP & SC INC 1 TH6320U1000INC
1PlatformLiner & New Top
Install New Condenser Pad 40 X 40 1 H022745
Dispose Of Old Equipment 1
1NewIn -Line Safety Float Switch
1CleanWorkAreaAtJobCompletion
1NewCodeApprovedHurricaneStraps
1ReconnectExistingSupplyPlenumtonewunit
1Permit
Paying By Credit Card
COMFORT SYSTEM PROPOSAL System Investment
Total $ 4,321
800 FOR COPPER IF LEAKING
Balance Due $ 4,321
Date 5/30/2018
Elizabeth Russell Proposal Valid Until ! 6/29/2018 Rodney Sinkfield
Page 1 of 2
This combination qualifies for a Federal Energy Efficiency tax Credit when
placed in service between Feb 17,2009 and Dec 31, 2016,
Certificate of Product Ratings
AHRI Certified Reference Number: 9154943 Date: 05-25-2018 Model Status : Active
AHRI Type: HRCU-A-CB
Outdoor Unit Brand Name: CARRIER
Outdoor Unit Model Number (Condenser or Single Package) : 25HBC524A'030'
Indoor Unit Model Number (Evaporator and/or Air Handler) : FB4CNP025L
The manufacturer of this CARRIER product is responsible for the rating of this system combination.
Rated as follows in accordance with the latest edition of ANSI/AHRI 2101240 with Addenda 1 and 2, Performance Rating of Unitary
Air -Conditioning & Air -Source Heat Pump Equipment and subject to rating accuracy by AHRI-sponsored, independent, third party testing:
Cooling Capacity (A2) - Single or High Stage (95F), btuh : 24000
SEER: 15.50
EER (A2) - Single or High Stage (95F) : 12.50
Heating Capacity (1-112) - Single or High Stage (47F) : 24000
HSPF (Region IV) . 9.00\ _.
t'Active- Model Status are those that an AHRI Certification Program Participant is currently producing AND selling or offering for sale; OR new models that are being
marketed but are not yet being produced'Produclton Stopped' Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still
selling or offering for sale. Ratirws that are accompanied by WAS indicate an involuntary re -rate. The new published rating is shown along with the previous (i.e. WAS) rating.
DISCLAIMER
AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for.
the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the
unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the
directory at www.ahridirectory.org.
TERMS AND CONDITIONS
This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for Individual, personal and As
confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; A.. -' entered Into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's Individual,
personal and confidential reference. AIR CONDITIONING, HEATING,
CERTIFICATE VERIFICATION REFRIGERATION INSTITUTE
The Information for the model cited on this certificate can be verified at www.ahrldlrectoFy.org. click on 'Verify Certificate' link we make life bet tee'
and enter the AHRI Certified Reference Number and the date on which the certificate was Issued,
which is listed above, and the Certificate No., which Is listed at bottom right. 13171i4o65ga2s39B7
2018Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.:
j.R =
Page t
880)-$32-96G5
24 Hours - 7 Days a Week 03/01/201e
State Cert CAC037449 WWW.DELAIR.COM
Elizabeth Russell 407-257-3194 5/3012018 Rodney Sinkfield
106 Brierwood Dr 407-221.6820 husband Email 407-497-4633
Sanford FL 32771 rsinklield0detair.com
DescriptionP SIZE SEER Delair AdjustedPriceRebatePrice
Carrier Comfort 15 Puron® HP 2.5 TON. 4,747 426 4,321
Carrier Limited Factory Warranty: 10 years all functional parts 1 on labor. Residential UseyearOnly
On a 93 Degree Day the inside 7emperattrre can be 78 and on a 30 Degree Day the Temperature will Average 70 Degrees
Enter Optional First Planned Maintenance Here
Recommended Optional Accessories 6 Extended Warranty Price Model Included
a. Basic Extended Warranty coverage includes equipment and standard thermostat b. basic
Extended Warranty coverage does NOT include Wili Thermostat. EAC, Damper Systems, or other accessories unless purchased separtely c. All Extended
Warranties require annual maintenance or coverage is void
t Extended Warranties _ _ ^ _ _ - $• - i Declined i
Optional IAQ Enhancements"
Efficiency Agreement " $ I — - —— Qt.l $
H X W X D Heater of Model
A/H 53 7116 X 21 1/8 X 221116 CE2601CIO 1
1
FUDNF0311-00
25HBC530COND325116-X 35 X 35 { -
Honeywell 3htg2clg Programmable HP & SC INC 1 TH632OU1000INC
Platform Liner & New Top 1
Instal; New Condenser Pad 40 X 40 1 H022745
Dispose Of Old Equipment 1
1NewIn -Line Safety Float Switch
1CleanWorkAreaAtJobCompletion
1NewCodeApprovedHurricaneStraps
1ReconnectExistingSupplyPlenumtonewunit
1Permit
Paying By ! CreditCard
COMFORT SYSTEM PROPOSAL System Investment
Total E - 4,321
800 FOR COPPER IF LEAKING
Balance Due E 4,321
F Date t 5/30/20181
Elizabeth Russell Proposal Valid Until ! 629/2018 t yjRodneySinkfield Page
t of 2
CITY OF
D SANFORD
FIRE DEPARTMENT
Building & Fire Prevention Division
Residential Permit Card
PERMIT NO. a ISSUE DATE: •
N _
lD
CONTRACTOR:
JOB ADDRESS: 1062 6 , `b- Ur
TVpF AF WORK! VkVAC _ 0,10
Post this permit in a conspicuous location outside Leave all work uncovered until inspected and approved
Approved plans must be posted with permit for inspection Permit ex ircs 6 months from date of issue or last approved inspection
PROTECT FROM WEATHER
ELECTRICALBUILDING
rNSPECTION TYPE APPROVED REJECTED INSPECTOR INSPECTIONTYPE APPROVED REJECTED INSPECTOR
ELECTRIC UNDERGROUNDFOOTERINSPECTION
STEEL BOND
STEMWALL
FORMBOARD SURVEY T.U.G. EEFOOTER/
SLAB
PRE POWER
ELECTRIC ROUGHSLAB / MONO -SLAB
ELECTRIC FINALLINTEL / TIE BEAM
MECHANICAL
SHEATHING - ROOF
TYPE APPROVED REJECTED DISPECTOR
SHEATHING - WALLS INSPECTION
MECHANICAL ROUGHFRAME
INSULATION ROUGH IN MECHANICAL FINAL
PLUMBING
DRYWALUSHEETROCK
INSPECTION TYPE APPROVED REJECTED INSPECTOR
UNDERGROUND ROUGH
LATH INSPECTION
FINAL STUCCO/SIDING
FIREWALL SCREW TUB SET
SEWER
PLUMBING FINAL
FIREWALL FINAL
INSULATION FINAL
GAS INSPECTIONS
FINAL SFR
INSPECTTONTfPE APPROVED REJECTED INSPECTOR
ROOF
GAS UNDERGROUND PIPEINSPECTIONTYPEAPPROVEDMECTEDINSPECTOR
GAS ROUGH -INROOFDRY -IN
FINAL ROOF GAS FINAL
MISCELLANEOUS / FINAL INSPECTIONS
INSPECTJONI7PE APPROVED REJECTED INSPECTOR INSPECTION TYPE APPROVED REJECTED INSPECTOR
FINAL DOORFINALDEMO
FINAL WINDOW
FINAL SCREEN ROOM
FINAL BUILDING OTHER
MOBILE HOME FINAL
FINAL SOLAR PANELS
FINAL POOL SCREEN
FINAL UTILITY BUILDING
MOBILE HOME TIE -DOWN
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMLIVt L' )VI Iv I IVII+ 11 JCL' ova. a _• - ^ • -• --
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH -
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: IN ADDITION TO THE REQUIREMENTS OF THIS PERMIT. THERE MAYBE ADDITIONAL RESTRICTIONS APPLICABLE TO THIS PROPERTY THAT MAYBE FOUND IN THE PUBLIC RECORDSOFTHISCOUNTY, AND THEREMAY BE ADDITIONAL PERMITS REQUIRED FROM OTHERGOVERNMENTAL ENTITIES SUCH ASwATER MANAGEMENT DISTRICTS. STATE AGENCIES OR FEDERAL
AGENCIES FBCIOS.7.3
Inspection Line: 107.792AO69 or ISS541.2112
REVISED: 4.17
TO SCHEDULE AN INSPECTION:
Dial 407.792.6069 or 855.541.2112
Provide the items requested during the message
The tyo 6f inspection requested must be scheduled under the'dp ropnate permit type
Follow the prompts
To Schedule Fire Inspections: Please call 407.562.2786 ***
PLEASE NOTE: Inspections scheduled by 5:00 p.m. will .be conducted the next business
day. If you experience difficulty, please call 407.688.5150 Monday - Thursday 7:30 am -
5:30 pm for assistance.
AUTOMATED INSPECTION SYSTEM CODES
BUILDING ELECTRICAL
FOOTER 104 ELECTRIC UNDERGROUND 211
STEMWALL 102 FOOTER / SLAB STEEL BOND 221
FORMBOARD SURVEY 147 T.U.G. 216
SLAB / MONO -SLAB 103 PRE POWER FINAL 218
LINTEL / TIE BEAM 105 ELECTRIC ROUGH 212
SHEATHING - ROOF 106 ELECTRIC FINAL 213
SHEATHING - WALLS 115 MECHANICAL
FRAME 109 MECHANICAL ROUGH 409
INSULATION ROUGH -IN 110 MECHANICAL FINAL 410
DRYWALL / SHEETROCK 131 PLUMBING
LATH INSPECTION 132 UNDERGROUND ROUGH 322
FINAL STUCCO / SIDING 130 TUB SET 312
FIREWALL SCREW
FIREWALL FINAL
120
143
SEWER
PLUMBING FINAL
311.
313
INSULATION FINAL 113 GAS
FINAL SFR 138 GAS PIPING UNDERGROUND
GAS ROUGH -IN
328
314ROOF
ROOF DRY -IN 116 GAS FINAL 315
FINAL ROOF III
MISCELLANEOUS / FINAL INSPECTIONS
PRE -DEMO 144 FINAL DOOR 136
FINAL DEMO 126 FINAL WINDOW 137
FINAL SOLAR PANELS 134 IRRIGATION FINAL 321
FINAL POOL SCREEN 139 FINAL SCREEN STRUCTURE 127
FINAL UTILITY BUILDING 124 FINAL BUILDING - OTHER 112
MOBILE HOME TIE -DOWN 145 MOBILE HOME BUILDING FINAL 146
Miscellaneous Notes:
REVISED: 4-17 Inspection Line: 407.792.6069 or 855.541.2112
FIRE INSPECTIONS CITY OF SANFORD
407.562.2786 BUILDING & FIRE PREVENTION
BUILDING INSPECTIONS 300 N PARK AVE
855.541.2112 SANFORD FL 32771
DRIVEWAYS -SIDEWALK 407.688.5080
Page 2
Application Number . . . . . 18-00002683 Date 7/23/18
Property Address . . . . . . 106 BRIERWOOD DR
Parcel Number . . . . . . . . 33.19.30.502-OCOO-0220
Application description . . . MECHANICAL PERMIT
Subdivision Name . . . . . . IDYLLWILDE OF LOCH ARBOR SEC 5
Property Zoning . . . . . . . SINGLE FAMILY
Permit . . . . . . MECHANICAL PERMIT -RESIDENTIAL
Additional desc . .
Phone Access Code 1057538
Permit pin number 1057538
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
1000 410 MH02 MECHANICAL FINAL / /
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: o (p
Documented Construction Value: S S . op
Job Address: I 0(o E)r f p C f Historic District: Yes No k]
Parcel ID: - - -5-%2 - UC W - 02?lJ Residential K Commercial
TviDe of Work: New AAditionia. Alteration tZ Repair. Demo Change of Use Move
1 .wwl_i.ill.ttslt+
Plan Review Contact Person: (-j(htZl'IC t PY\ /fit 11L,2 l
Phone:Email:
Phone:01- M -7- NQy
Street: (off 6 D—r Resident of property?: y {
City, State Zip:cz t,rC,._)
Contractor Information
Name%_ V I V Q. Phone: UrJ- 33 3 -2LyCo S
Street: Yx21'i' 2 Fax: - 2, 3o _
City, State Zip State License No.:
ArchiteldlEngineer Information
Name: Phone:
Street:
City, St, Zip:
Bonding Company:
Address:
Fax:
E-mail:
Mortgage Lender:
Address:
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
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 construction
in this jurisdiction. I understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools,
furnaces, boilers, heaters, tanks, and air conditioners, etc.
no
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 51° F.dilion (2014) Florida lJnildinz.Cude
Revised: June 30.2015 Permit Application
YDl'IC'E: In addition to the requirements of this permit, there may be additiunal reshictions applienble to this property that may he
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 1 will notify the owner of the property ol'the requirements of Florida Lien Law, FS 713,
The City of Sanford requires payment of a plan review fec at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will 6c figured based on the cun•cni 1CC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
OW.N. ER'S-AlffRIDAVIT: 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.
Signature: of Owner/Agent pole
Prn.1 Owrira/Agent', Name
Owner/Agent is _ Personally Known to Me or
Produced ID 'Type of ID
h H • rm4,rn
Prtm Contra r/Agent's Name
I I E JFlorsale My
Comm. Expires Jan 26, 2 Commission /
FF 076322 Contractor/
Agent is__e PtrsbnallyKnown to Me or Produced
ID Type of 1DBELOW
IS FOR OFFICE USE ONLY Permits
Required: Building Electrical Mechanical Plumbing[] Gas Roof Construction
Type: Occupancy Use: Flood Zone: Total
Sq Ft of Bldg: Min. Occupancy Load: # of Stories: New
Construction: Electric - N of Amps Plumbing - # of Fixtures Fire
Sprinkler Permit: Yes No # of Heads Fire Alarm Permit: Yes No APPROVALS:
ZONING: UTILITIES: WASTE WATER: ENGINEERING:
FIRE: BUILDING: COMMENTS:
Itrvr'
ed lone I:r•:•t'C Pcnni:Applariun