4595 St Johns Pkwy 04-642 Electrical for sprinklerCITY OF SANFORD PERMIT APPLICATION
Permit # : - I a / C) 3
Q
Date:
Job Address: /S 7 S J` 70H-rJ:S R X,,.,6gZ
Description of Work: Z C T?2cC t YL111ce ro(t St Lit4 Fi2c?2 AtN 1 t l C i4?zo 7 OyV 1, o r`p
Historic District: Zoning: Value of Work: S
Permit Type: Building Electrical X— Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS f o n 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 ether than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: CITY o F S>V(--,o en Tg,(z-KS t} (ZOUNas OPS
0 ::52X 1-7 8 $ SEP ;aW 'c. 3A77a1- 178$' Phone:
Contractor Name & Address:—DzeirFi C CO N i rZOl 19"I CE5 -IT-(5> }} f13 `D, K O CT
Suo Wlr F9A9KItN Q7&-'oPT YR(1 6S 6e3 A7 1 `/ State License Number: EC 0 p 0O SO/ Phone&
Fax: Yo%$(09S3®o A'c>7,aRa AO Contact Person: kaKi- Y1Cr2Phone: Sal oaAq Oga(o Bonding Company:
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 requirements Signature of
Owner/Agent Date SiZiYe of Print Owner/
Agent's Name Signature of
Notary -State of Florida Date of Lien Lav4efS
713. fi,T
Agent's
Naf FLO CEA.
DE V E IS:
November 12,1 Bonded Thru
Budget Notary Services Owner/Agent
is _ Personally Known to `Cgtractor/Agent i PersonallY,Known to Me of Produced ID
1' ' Produced ID U.)CiC3 Sy _ ' dC d JAPPLICATION APPROVED
BY: Bldg: Zoning: Utilities: FD: i ial &
Date) (Initial & Date) (initial & Date) (Initial & Date) Special Conditions:
DEVICES, INC.
P.O. BOX 150418
ALTAMONTE SPRINGS, FLORIDA 32715-0418
407) 869-5300
Date: I Z 4.0 3
I hereby name and appointyi te.t2C of Traffic Control Devices, Inc. To
be my lawful attorney in fact to act for me and apply to the f M 1 , It 61caA-IL BuildingDepartmentforanelectricalpermitforworktobeperformedatalocationdescribed
as: Section:
Subdivision:
Township:
Lot: Block: q
t;Fi 1J J7Y [ 1L3 C ,L JK1tV t?rr 4 Address
of job) CJJ
fo* 3Ar S, Owner
of Property and Address) And
sign my name and do all things necessary to this appointment. Sincerely,
0.
0,-L IQ 0 hn
D. Holt EC0000893
Traffic
Control Devices, Inc. The
foregoing instrument was acknowledged before me this 18 day of J)%eCC.jn b"', 20t) 3 who
is personally know to me and who did not produce identification and who did not take
an oath. STATE
OF FLORIDA COUNTY OF SEMINOLE COMMISSION # '
Dj MY COMMISSION EXPIRES I - - govis
Shannon Mester o
NOTARY
PUBLIC STATE OF FLORIDA Y+
tiN
commission DD165858 or
R/ Expires December 06, 2006 a
EVICES, INC.
P.O. BOX 150418
ALTAMONTE SPRINGS, FLORIDA 32715-0418
407) 869-5300
Date: 12-1 Ss- c3
I, John Dewey Holt, (EC0000893) do hereby grant permission to the following persons to
obtain from your department, Permits required for Traffic Control Devices, Inc. only.
Bruce J Leach
Keith Cockman
Elbert Barnes
Kurt Dietze M ..
April Andrews '
Tony Duncan
George Hamil
Jeff Anderson
Sincerely,
e • i4&d-
Holt
EC0000893
Traffic Control Devices, Inc.
The foregoing instrument was acknowledged before me this day of '—pecan. 20k?
who is personally know to me and who did not produce identification and who did not
take an oath.
STATE OF FLORIDA COUNTY OF SEMINOLE
COMMISSION # MY COMMISSION EXPIRES i-D-(o -0/p
N1 ",1 Shannon MasterlAv_
NOTARY PUBLIC STATE OF FLORIDA. MY Commission DD165858
or n. Expires December 06 2006