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3085 St Johns Pkwy 04-1589 Fire Sprinkler monitorf ! u CITY OF SANFORD PERMIT APPLICATION ! Permit # ; � ` • �� Q Date: Job Address: `3 `� 54 1+4 S / �L'��1�) Description of Work: Historic District: Zoning: Value of Work: S 1 � ©� • o Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarni / Pool 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 Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: Gl y1'3 Q 5/-I_E - 43 c `D 0Q (Attach Proof of Ownership &Legal Description) , Owners Name & Address: S� b W �l 1� 1 �} l t Contractor Name & Address: }t"1 �Y{ (� ( t fZl= �e� • `7 %{ .0 SAT Phone & Fax: Bonding Company: Address: 6000 '7WU U /V:: Phone: _:5)'"t_� Ttortgage Lender: 4r Address: MAR 2 U Architect/Engineer: r t qtu Phone: Address: -- � FMA� f t l I I m Fax: Application is hereby made to obtain a permit to do the work and jn lati na in$icaed'ify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet siatiida dss of all laws regulating construction in this jurisdiction, l understand that a separate permit must be secured for ELECTRICAL WORK,:PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, I{FATERS,'FANKS, 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 W found in the public records of this county, and there may be additional permits required from other governmental entities such as management districts, state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of th, (Itzk1fJ rid a Lien L - FS 713. / Signature of Owner/Agent Date Signature of Contractor/Agent Date W/A/J- /4icam)r�l� Print Owner/Agent's Name Print Contractor/Agent's Name .611 Signature of Notary -State of Florida Date Date k * MY COMMISSION # DO 2W22 — EXPIRES: March 23, 2008 wrFCF Floe>° Dunded Thru NdpQet Notary Services Owner/Agent is Personally Known to Me or Contr ctor/ gem is —_ 'ersot Ily ngwn to Me or Produced [Droduced lD _eL� L (� It?<)o 1. APPLICATION APPROVED BY: Bid :1 � �U � Lonin Utilities: hD h �'.. g: (Initial & Date) (Initial & Date) (initial & Date) ° Special Conditions: ep N. 0 � . , " AT, V d, M=E , Q •