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�?> CITY OF SANFORD PERMIT APPLICATION Z
�%Date: 5/31/02A 3N.,-
Permit No.: /
Job:.Address:
200 NORTH STAR COURT,SANFORD, FL 32771
Permit Type: Building Electrical Mechanical Plumbing X Fire AlxraslSprinkkr
'Description of Work.`ADD EIGHT ( 8) PENDANT SPRINKLERS:
Additional Information for Electrical & Plumbing Permits
Electrical: Addition/Alteration Change of Service Temporary Pole _New AND Scrvicc 0 of AMPS
Plux0ing/Residential: Addition/Alteration New Construction (One Closet Plus Additional)
Plumbing/Commercial: Number of Fixtures Number of Water & Sewer Drainage Lines Numbcr of Gas Lincs
Occupancy Type:, L Residential _&_Commercial _ Industrial Total Sq Ftg; ILA �� Value of Work: 5 q85,��
Type of Construction: RXTSTTi\ 1 Flood Zone; Number of Stories: I— Number of Dwelling Units:
Parcel No.: 28-19=30-508-0000-0040 (Attach Proor of Ownership & Legal Description)
Owner/Address/Phone: CONRaD CONSTRUCTION TNS' P Q BOX 470428 LAKE MONRORF,FL 32747
PHONE: (407) 330-3238
Contractor/Address/Phone: 1 (407) 328-3000
DELTA FIRE SPRINKLERS, INC. 111 ,TECH DR. SANFORD,
FL74��40000190
CHARLES W. MONTOMGERY State•License Number:
Contact Person: KAREN M. BINNER Phone & Fax Number. 407) 328-3000 EXT s143 FAX:' 32$-3001
Title Holder (1f other than Owner):
Address:
Bonding Company: N/A
Address:
Mortgage Lender: N
Address:
Architect/Engineer N/A
Address:
Phone No.:
Fax No.
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,
Q•_•WNER'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. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT,
NONCE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may bo
found in the public records of this county, and there maybe additional permits required from other goverumcntal entities such as
water management districts, state agencies, or federal agencies. n
A gptance of permit is verification that I will notify the owner of the property of th(rrequirem _ts of Flo, 'da Lien L>Iiw, FS 713,
(P/,�" 102. ' 5/31/02
Signature of Owner/Agent Date Sibwure of Contract r/Agent Date
CHARLES W. MONTGOMERY
rid'. "fer�gent'sName
"� / J6�innContractor/Agee"s ame
—� t----� .. -
5/31/02
Signature ofNotary-State of Florida Date S lure of Notary -State of Florida Date
Lucy L, Hise
;)OR'nAl(
# CC 1304119
xpires Jan. h42003
Owner/Agent is 1 P Q,lwanii '�,�ho Inc.
Produced 16' ��'�'
APPLICATION APPROVED BY: `e (, ,-y,
U40k.ge KAREN M. I31NNER
;1,
r .'
• „� ,titY COMMISSION # CC 823334
a fOf F�` rXPIRES: April 4, 2003
1 -800.3 -NOTARY 'r'la. Notary Servi ndirq Co.
,Contractor/Agent is Wally Known to Me r
ProducedlD �_
Date: Zo - 0 2—
Special
Special Conditions'. _3 Vs` z rr),-.
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