HomeMy WebLinkAbout1511 San Jacinto CirP1aRs ;r C�S�ea- f; le,
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CITY OF SANFORD PERMIT APPLICATION
Application # : .. 1— l 7 8 9 Submittal Date: 4 I �rQ /
Job Address: I S I I Sart aCi MO C\ y Ap- �Of � 29
/ Value of Work: $ ,� % n 3 . 010
Parcel ID: Zoning: Historic District:
Description of Work: �05 GM �e 5QyAb0—X M0(1+0y� fl`E, 5&M Square Footage:
...........................................................................................................................
Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm X Pool ❑ Sign ❑
Electrical: New Service — # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non -Residential ❑ Replacement ❑ New ❑ (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑
Construction Type: # of Stories: # of Dwelling Units:
# of Gas Lines
Plumbing Repair— Residential ❑ Commercial ❑
Occupancy Use Group(s):
Flood Zone: (FEMA form required)
............................................................................ ....... . ..... ... .. .....
... ... .. ..L., ..... ....
Property Owner: Contractor:
9�u (1e. �l,c�cmQ�i C re 5 OC n ICLI(S
L
Address: Address: —71 +0k r+
Ocoee. cwt STWe I _
Phone: E-mail: Phone:` 747-%-5-tate License Number: EC2Ooa3S?
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Lender:
Address:
Phone:
Fax:
Phone: Fax:
E-mail:
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.
OWNER'S AFFIDAVIT: 1 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.
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.
.►41Q�W LI -1-7-6-7
Signature of Owner/Agent Date Signature of Contr ctor/Agent Date
DaRRQ HarrC
Print Owner/Agent's Name Prin ntrac or/Agent's Name
-7-0-7
Signature of Notary -State of Florida Date Signal re of Notary -State of Florida Date
It" Rebe=g S. Romeg
F N1y CommiSGian DD239311
or V Expires Auaust na inn -7
Owner/Agent is_ Personally Known to Me or
Produced ID
APPROVALS: ZONING: UTIL:
Special Conditions:
Rev 02/2007
Contractor/Agent is y Personally Known to Me or
Produced ID JAW)
FD: ENG: BLDG:
. . . . . ...... 7
CITY OF SANFORD FIRE DEPARTMENT
FEES FOR SERVICES
PHONE # 467-302-2516 • FAX # 407-302-2526
DATE 1/7 PERMIT #:
r
BUSINESS NAME /.PRO,JECT:
ADDRESS:
PHONE NO.: FAX NO.:
CONST. IN P. C 0 INSP.:[ REINSPECTION PLANS REVIEW
F. A. F.S.HOOD PAINT BOOTH BURN PERMIT
TENVERMIT NK PERMIT OTHER
TOTAL FEES; S (PER UNIT SEE BELOW)
Address Bldg. # Unit # Square Footage Fees per Bldg. Unit
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
13. 5.
16.
17.
18.
19.
20.
Fees must be paid to Sanford Building Department, 300 N. Park Ave., Sanford, Fl. 32771 Phone # -407-
330-5656. Proof of Payment must be made to Fire Prevention division before any further services can take
place. I certify that the above is true and correct and that I
will comply with all applicable codes and ordinances
of the City of Sanford. Florida.
rr
Sanford Fire Prevention Division Applicant's Signature
6
I I .
WW,-WA"E
'Automatic Fire Sprinklers, Inca
LETTER -OF AUTHORIZATION
Date: ` May 7, 2007 .
To: City of Sanford
Re: Flagship Park
This letter is to authorize Tyler Dyal to hand deliver, pick-up. and/or sign for, our,
permit for the above •referenced project on my behalf.
Thank You! -
Danny R. flarrod
State Certificate #EF20000358
Before me personally appeared Dannv R. Harrod, to me well known and known, to
me to. be the person -described in and who executed the foregoing instrument.
Witness my hand and official seal this 7th day of -May, 2007.
MY COMMISSION EXPIRES: 14
Signature of Notary
RUTH A.M000LLOCH Ruth A. McCulloch .
MY COMMISSION # DD 485633 - Name of Notary typed or printed
EXPIRES, February 26, 2010
Bonded Thru Notary PON Undarntl®r
Corporate Office: 222 Capitol Court Ocoee,.Florida 34761-3033 (407) 656=3030 • FAX (407) 656.=8026
Regional Offices Jacksonville Fort Myers Pompano Beach • ' Port St. Lucie,- Tampa Concord, NC