2200 Red Cleveland Blvd 05-2316 Fire sprinklersMar 24 05 08:33a Citi of Sanford Building 407 328 3859 P.1
CrrY OF SANFORD PE 1 APPLICATION
Permit # : _ O — P Date:
Job Addrsss-ztq9-'?'Gj 0-w5bE_R,.1 1 9a C—A-1 xA a t1 t .
Description of Work:
Historic District: Zoning: Value of Work: S 2, 100.00
Permit Type: Building Electrical
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Mechanical Plumbing Fire Sprinkler/Alarm I, -,Pool
Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Cale. Required)
of Water & Sewer Lines # of Gas Lines
Plumbing Repair- Residential or Commercial _
Industrial
Construction Type: # of Stories: # of Dwelling Units:
Total Square Footage:
Flood Zone: (FEMA form required for other than X)
Parcel #! (Attach Proof of Ownership & Legal Description)
Owners Name & Address: QZ.LhYTuRju -no"i3'L 4A"OiT
7X9-Cl_q e L45,l)i 1441VC?,&,) Y Phone:
Contractor Namc & Address: Utak tV-&-L. Y9i 0V'A%3Ar k
Phone & Faz: LIOr%'Z73-? 7(iL/., LZ - %ab1. Con
Banding Company:
Address:
Mortgage Lender:
Address: MAR 9 Z005
Archilect/Engineer: "' 4 Phone:
Address: Fa
Application is hereby made to obtain a permit to do the work and installations as indicat I crit thwx ,i _ llation has commenced prior to the
issuance bf a permit and that all work will be performed to meet standards of all lawsrelagonstttcooninthisjurisdiction. I understand that a separate
pernit 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 FA ILURE 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 b"dditional 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 require encs of Florida Lien Law FS 713.
Signature of Owner/Agent Date gignature of Contractor/Agent Date
El,/&iJ BA)rut&T r
Print Owner/Agent's Name Print Contractor(Agent's Name
3-z',bS
Signature of Notary -State of Florida Date Signature of Notary -S da
zet'
a, . ROBERT FARRELL
MY COMMISSION # DD 170018
EXPIRES: March 8, 2007
Bonded Tluu Budget Notary Services
Owner/Agent is _ Personally Known to Me or Contractor/Agent is _ Personally Known to Iv)`E6i
Produced ID _ Produced m
2
APPLICATION APPROVED BY: Bld Ll `l L Zoning: Utilities: FD: . -
Initial & Date) (Initial & Date) (Initial & Date) (Initial &Dan)
Special Conditions:
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