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HomeMy WebLinkAbout184 Towne Center Cir (2)Permit # : ©-- h p 8 4 Job Address: /OG'/ Towne Description of Work: Ackci A- 2Q Historic District: Zoning: RECFIVED CITY OF SANFORD PERMIT APPLICATION A i h v 6 LUU / lor_4-k So,-; Date: V-2-07 Value of Work: S /31c O Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool r 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 # of Gas Lines Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial Occupancy Type: Residential Commercial '�_ Industrial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood zone: (FEMA form required for other than X) Parcel #: Owners Name & Address: Contractor Name & Address: Phone & Fax: Yo/ Bonding Company: Address: Mortgage Lender: . Address: Architect/Engineer: Address: (Attach Proof of Ownership & Legal Description) Phone: Lnikkj, f -L 3280-1 State Lfcense Number: y71JZOO 420V l Contact Person: 2( ah Aj^K Phone: Ya7 23S Phone: Fax: 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: 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. 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. Signature of Owner/Agent Print Owner/Agent's Name Date 12.4=n7 — 4%Z & � SignaN f Contractor/Agent Date Signature of Notary -State of Florida Date �amre of N Owner/Agent is ___, Personally Known to Me or Produced ID _ APPLICATION APPROVED BY: Bldg: Zoning: (initia Date) Special Conditions: Contractor/Agent is/ Personally Known to Me or _ Produced ID F D: (Initial & Date),. / Utilities: (Initial & Date) (Initial & Date) 6If1 SUSANNE ANITA JANS@NS NOTARY PUBLIC - STATE OF FLORIDA 3 pQa COMMISSION #DD477401 MY COMMISSION EXPIRES OCT. 2, 2009 t� CITY OF SANFORD FIRE DEPARTMENT FEES FOR SERVICES n PHONE # 407-302-1091 * FAX #: 407-330-5677 DATE: .� / PERMIT #: BUSINESS ADDRESS: PHONE NO.: FAX NO.: CONST. INSP. [ ] C / 0 INSP.:[ ] REINSPECTION [ ] PLANS REVIEW 'k F. A. [ ] F. S. [ ] HOOD [) PAINT BOOTH [ ] BURN PE [ ] TENT PERMIT,[ ] TANK PERMIT [ ] OTHER j TOTAL FEES: $ � (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. 15. 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. Applicant's Signature I