HomeMy WebLinkAbout350 Persimmon St (3)or] y 06— j CITY OF SANFORD PERMIT APPLICATION
Permit # : J Date: �P� (— _1 ' n� REGCe
Job Address: � i rn �-1 I %C�GK V��
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Description of Work: r I w W Total Square Footage 3%I ZQO�
Historic District: Zoning: Value of Work: $ / ��� 00
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkle Alarm —Zpool
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
Construction Type: # of Stories:^^ # of Dwelling Units: Flood Zone: (FEMA form required)
Owners Name & Address: In Oct -t- W r t
��� Psi k" �'Scnn .Sl- � vl ,-�, FL_ 3�7� 1 Phone: 4d���35- �o�
Contractor Name & Address: l K V k� CAK'rY rr2rQ- `"'�
Sa - 7PState License Number: a"Ila(v606 kD003
Phone & Fax. � �i2� I (D(n3>/F �go,l�2s g71>}i ontact Person: �y� P +.1'�
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CPhone:
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Bonding Company: N �1)
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address:
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 requirem is of Florien Law, FS 713.
Signature of Owner/Agent Date Signature of o ractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID n
APPROVALS: ZONING: UTIL: FD:;
Special Conditions:
Rev 03/2006
FV e (A l Lt --Da
Print Contractor/Agent's Name
SignItture of Mtary-State of Florida Date
Contractor/Agent is Personally
Produced ID A ! 14
ENG:
notary t-uunc aune ui rwnut
Jacqueline S Court
My Commission DD595606
as r Expires 10/25/2010
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CITY OF SANFORD FIRE DEPARTMENT
FEES FOR SERVICES
PHONE # 407-302-1091 * FAX #: 407-330-5677
DATE: PERMIT #:
BUSINESS NAME / PROJECT: A -
ADDRESS:
PHONE NO.: 3,FAX NO.: a ��
CONST. INSP. [ ] C / O INSP.:[ J REINSPECTION [ ] PLANS REVIEW
F. A. [ ] F. S. [ ] HOOD (] PAINT BOOTH [ ] BURN PE ]
TENT PERMIT J TANK PERMIT [ ] OTHER_, et a_
TOTAL FEES: $ 0C) (PER UNIT SEE BELOW)
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Address / Bldg. # / Unit # Square Footalze Fees per Bldg. / Unit
1
12=
Fees must be paid to Sanford Building Department, 300 N. Park Ave., Sanford, F1. 32771 Phone 4 -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
will comply with all applicable codes and ordinances
of the City of Sanford, Florida.
Sanford FirePreve ivision Applicant's Signature