1621 N Rinehart Rd 06-3111 sprinkler��'y�nr ] 1
L./ W J J CITY OF SANFORD PERNIIT RECEIVED
APPLICATION AUG
Permit # : t/�..a'"`..o."�� f i "i'.�-,'p '—' t Date: ( "` �G'
2006
Job Address: --
Description of
Historic District: Zoning: Value of Work: $ 2' (r 0
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarrn Pool _
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 'Total Square Footage:
Construction Type: # of Stories: # of Dwelling Uuits Mood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & LegaLllescril;f€ott)
Owners Name & Address:
!'hone:
Contractor Name &Address: 4Y / 12 r),� �
State LicenseNumber:
Phone & Fax: 10 7- (�� Q �' 7 Contact Person: _ /� 6 �C1�7� Phone:
Bonding Company: _
Address: `-----�
Mortgage Lender:
Address.__.._.,....._.._—
Architect/Eugineer: 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 comtmenraad pdcle to the
issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. [ undcrst nmd'tbta u tu;hauate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, IIEATERS, TANKS, acid
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: t certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicalmh;: tawtm tegulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT f1\1 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENOL,1, OK A.14
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 pt i;lic t,-re'artls of
this county, and there may be additional permits required from other governmental entities such as water managentent districts, state agencicy, or faiele,cak agencies.
Acceptance of permit is verification that I will notify the owner of the property of the
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is ._ Personalty Known to Me or
Produced ID�_
APPLICATION APPROVED BY: Bldg: Zoning:
(hii D te)
Special Conditiuns:
FS 713.
r
Priniw;ontractor/Age
Date(
-/you c
of Notary -State of F rich Date
LINDA L. PHILLIPS
Contractor/Agent isti . Personally Known to McOotary Public, State of Florida
Produced w� —My cumrr sex Sep : 29y 200(
A 117Pi9r�DD,154192
I n�__
(Initial &Date) (Initial &Date) (f tt I
T • � 9 i.
Utilities: