HomeMy WebLinkAbout205 Towne Center Blvd (2)CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: Documented Construction Value: $`7 1
Job Address: AM Th L 11e_ C C':C1 2 lb1\16 Historic District: Yes No IR
Parcel ID: v'j-k 1 -4 A )-- Zoning:
Description of Work: hCn kOQ V-kt-01. \!,) I-1 C e— Lip (\\Q ( heRC 2, -A 1A33 S 4 -)DO-CAS
Plan Review Contact Person: \I \\ Q )\ fzz i \'\k A Title: ; 9-ko 1Z\
Phone: \A0-1 Fax: 1 . 7 _14 )QZ`l E-mail: )tSy'.0 \\ A Oct, reA- Kctr\ tcS. Crn1 Property
Owner Information Name
Street:
City,
State Zip: Phone:
Resident
of property? Contractor
Information Name
CA) Re_e 6gPhone: 401- 114 - (oq00 Street:
10;,:S i \ c\,e- VN la\\Cv-,, 3)0fN- Fax: 401 - 1-14 - 2-0-74 City, State
Zip: % A I-1- State License No.: (.a>4 e\0I CCQ I a CCCS Architect/Engineer
Information Name: Phone:
Street: City,
St,
Zip: Bonding Company:
Address: Building
Permit
Square Footage:
No. of
Dwelling Units: Electrical New
Service -
No. of AMPS: Fax: E-
mail: _
Mortgage Lender:
Address: PERMIT
INFORMATION
Construction Type:
Flood Zone:
Mechanical (Duct
layout required for new systems) No. of
Stories: Plumbing New
Construction -
No. of Fixtures: Fire Sprinkler/
Alarm Lti' No. of heads:_ I
s
i
I
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 pen -nit 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.
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.
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.
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 requirements of Florida
Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
of Owner/Agent
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
11
Signature of Contractor/Agent Date
fie\ Ley 5
P6 t Contract Agent's Name
Signature of Notm -State f Florida Date
roti Y ppp Notary Public State of Florida
Vicky Spinella
N o My Commission,DD788856
oF r o Expires 0511,4/2012
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
WASTE WATER:
BUILDING:
Rev 11.08
LIMITED POWER OF ATTORNEY
s
t
Date:
I herby name and appoint Linda Bean an agent of Firetronics, Inc. to -be my
lawful attorney -in -fact to act for me to apply for, sign for and do all things
necessary to this` appointment for (check only one option)
permits and applications submitted by this contractor
The specific permit and application for work located at:
Street Address)
1% -- Expiration Date for This Limited Power of Attorney: l
W-IX
gnature of Certified Contractor))
Michael W Lewis #634901,00012005
Printed Name of Contractor and License Number)
STATE OF FLORIDA COUNTY OF: Seminole
The foregoing instrument was acknowledged before me this V day of DIN / 200,
by, Michael W Lewis, who is 0 personally know to me or has produced (type
of identification)'.
CU
Signatur of otary Nblic, State of Florida (SEAL)
Vicky Spinella
Print/ Type/Stamp Name of Notary Public
eW I % Nofzry Public State of Florida
NotaryPublic— State of Florida` r° °/ick,y Spinella Commission
No. DD788856 „ t a My Commission DD788856 My
Commission Expires: 05/14/2012 '?QF°I Expires05/14/201-2