HomeMy WebLinkAbout2521 S French Ave (2)a 'N/
CITY OF SANFORD PERMIT APPLICATION
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Permit # :_ _ 0(ry')-3 Date: t?T.dro
Job Address:all 3.7--771 wE
Description of Work: SySayS1 Total Square Footage
Historic District: Zoning: Va, lue- of Work: $ 7('0Y- L 0
Permit Type: Building Electrical ' Mechanical Plumbing Fire Sprinkl r/Alar Pool
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Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cale. 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:
Phone:
Uontractor Name & Address: Sk p't* A1--4vt'r." T". C-
7So4 W %t," Qo, SVC 1 014 33 r97 State License Number: CG 13 000- ,S `7
Phone & Fax: ik.07- 3 Wo -G70 Contact Person: t'c" Phone: 410')- 'tq-14 Y Chu
Bonding Company:
Address:
Mortgage Leuder:
Address:
Architect/Engineer:
Address:
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 i verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
Sign r of Owner/Agent Date Signatur Contractor/Agent ate
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Pri Ownegm
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0 1 1t1 ro Signature
of Notary -State of Florida Date Signature of Notary -State of Florida Date dh
MAW
E LEVINE No"
Pdk • State o1 Floft : ,0A N41NANETTE LEVINE My Ga
on E*W Mlle 5, 21m9 :: ° : Notary Public - State of Florida Owner/Agent
is now B 0 DD 391054 Contractor/Agent is _ P I Y4i'1 Expim Mar 5 2M Produced ID
ASSn. _Produced ID '.' S DD 391054 ceded . Assn.
APPROVALS: ZONING:
UTIL: FD: c ENG: BLDG: Special Conditions:
Rev 03/
2006 n
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STATE ALARM SYSTEMS INC.
2502 JMT Industrial Dr., Unit #105, Apopka, FL 32703
8632 Edge O'Woods Ct., Orlando, FL 32819
Telephone: 407-376-6713 — 407-351-9029 Fax
1-888-726-8111 Customer Service; 1-800-321-7400 Central Station 330-726-8104 Fax
FL CERTIFICATION LIC #EG13000257
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PLANS REVIEWED
CITY OF SANFORD
PERMIT #F
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OFFICE
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CITY OF SANFORD FIRE DEPARTMENT
FEES FOR SERVICES
PHONE # 407-302-2516 - FAX # 407-302-2526 _
DATE: PERMIT #:If
BUSINESS NAME / PROJECT:
ADDRESS:
PHONE NO.: FAX NO.:
1 C / O INSP.:[ j REINSPECTION [ ] , PLANS REVIEW T
F. A. F.S. .1 HOOD [ 1 PAINT BOOTH [ 1 BURN P RMIT [ j
ERMIT f j ,trANK PERMIT[ ] OTHERif [ ] TOTAL FEES: S C7 rJ (PER UNIT SEE BELOW)
Address / Bldp- # / Unit # Square Footage Fees per Bldg. / Unit
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Fees must be paid to Sanford Building Department, 300 N. Park Ave., Sanford, FI. 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.
Sanford Fire Pr ention Division Applicant's Signature
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