HomeMy WebLinkAbout2430 French AveF 4..
CITY OF SANFORD PERMIT APPLICATION
Permit # :
p. 0 — f 7 Date:
Job Address: , ',q.
Description of Work: S { Total Square Footage
Historic District: Zoning: Value of Work: S 2VOVO
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration
Mechanical: Residential Non -Residential Replacement New
Plumbing/ New Commercial: # of Fixtures —4P-- # of Water & Sewer Lines_
Change of Scrvice Temporary Pole
Duct Layout & Energy Caac. Required)
of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Dccupancy Type: Residential Commercial Industrial
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
owners Name & Address: r7 n SC 4
Phony.
ontractor Name & Address: % v ia7 i iv 02
j /,
7I per+, .
State License Number: CZ 11%.2p Jr
hone & Fax: 41O/— A , 3 'J g Contact Person: oK/ VAKi Phone: •7' I'
3onding Company:
ddress:
Mortgage Leader:
ddress:
rchitect/Engincer:
ddress:
Phone:
Fax:
pplication is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the
ssuance of a permit and that all work will be performed 10 meet standards of all laws rcgulatmg construction in this jurisdiction. 1 understand that a separate
oennit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS. POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
iR CONDITIONERS, etc.
WNER'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
onstruction and zoning. WARNING TO OWNER YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
WICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
TTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
40TICE: 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
his county, and there may be additional permits required liom other governmental entities such as water management districts, state agencies, or federal agencies.
eceptance of permit is verification that 1 will notify the owner of the property of the rcquiremc f
FIX
w, FS 713. $\-
w YSignatureofOwner/Agent Date nature ontractor/Agent ; cv:...
Print Owner/Agent's Name Print Contractor/Agent's ame
ail` 8 o'•OQ
Signature of Notary -State of Florida Date Signature of Notary -State of Flori 'C c'
pate O\\0\
lil lllilil•
OwnedAgent is _ Personally Known to Me or
Produced ID
rPPROVALS: ZONING:
pecial Conditions:
cv 03/2006
UTIL: FD:
Contractor/Agcni is, Personally Known to Me or
Produced ID
ENG: BLDG:
aA A-1•t) 6
To: Jon AdIan Page 2 of 2 2006-10-02 13 21 26 (GMT) 18133156243 From: Fortress Construction Solutions
TOM ill MkW, POQL
RLWLAON SMGLES 7-MAL
R.-I CEILING
PR"OWFR OTHER PdOL GROUND
STATE OF FLORIDA — ---,
f DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF EXEMPTION FROM FLORIDAWORKERS' COMPENSATION LAW „
EFFECTIVE: 04/ 13/2006 * *
EXPIRATION DATE: 04/12/2008.
ISPERSON: JON P JULI e
FEIN: 6 272VAVc
2
rV II
IE71 JULIAN"PLUMBI4. NGi11CJ N jL ccccttt
1317'CLOVER LAWN AVE tLANDO, '
FL 32806 SCOPE
OF BUSINESS OR TRADE: 1-
CERTIFIED PLUMBING CONTRACTOR I AG#
2702SIL- 0STATE
OF
FLORIDA DPOF
BUSINESS ROFESSIONAL
REGULATIONND CFC1426156
08/08/06 068023286 CERTIFIED
PLUMBING CONTRACTOR JULIAN,
JON PAUL JULIAN
PLUMBING INC IS
CERTIFIED under the provisions of Ch.489 Vs. Expiration
data: AUG 31, 2008 L06080801021
Oct 02 2006 9:44RM HP LRSERJET FRX
1
P.1
CONTRACTOR PJWISI'RATION APPLICATION
C-0 of Surd
3M N. Parr Avmue P. Q Doz IM
Saiahr+d, FL 32772.1785
407) 330.5M or (407) 330-MIJ
FAX (407) 32&3M
1. Businew.Nam /,-"
2-. Business Mailing Address;
city 6,P ZWJ= Sta/ Ir
3. Business Phone y0 7 N - .33aZ Fan
4. Name of QuaJi$ar on State Litxaae
5. State license Classification
6. State license Number
Vi- ff3-s'si
ism
Ppbcut's Signature
It State cardned: Must provide a caplr of cunt State 6oeuse and oc cupadonal license;
Certificate of Walomn's Cordon Insurance or Waiver Ate. $10 00 registration
will be assessed in Bw of a carnet occupational license.
IfState Readrtered; Must provide a copy of current State license and occupational license;
Certificate of Workmen's Commotion insurance or Waiver Affidavit; a 52,000 Surety Bolu; a
Letter of Reciprocity sea from akm the it R Block eamn urea taken; a City of Sanfor
ComPMncy Card will be issued. $10.00 registration The will be assessed in lieu of a current
occupational license.
All Otbar Sneeldu Cootrseam: Must pmvide a CertificM of Worlknm's Compensation
hmnance or Waiver Affidavit, a $2,000 surety boo& A $10 00 fee registration will be assess
0**0 Certificates of lnsraanee shall fiat the City of Sanford as a ca tdicaae holder: '*•''
1w!!sRlw!•ww!!!R!!!!! OFFICIAL USE ONLY •!!!!!!!R!!!!RR!!!!Rf
Control # City won #