28 Mission Blvd - BC11-002074 - FIRE ALARMApplication No: I I C) -1 Ll
A99 B gy 20 CITY F SANFORD
IILDING & FIRE REVENTION
PERMIT APPLICATION
Documented Construction Value: S S, 3)3 3. U O
Job Address: 2 S W 5S1 o n i2,1\i CA + , Sa Y AVcl 3"1-1 Historic District: Yes No
Parcel ID: 31-1(i- 3 U 0- Oy d- O -U o O a Zoning: Description
of Work: r Plan
Review Contact Person: WAijOtO, AVY1 n b Yt S Title: s ' (uC/
64 Phone: q
U 7- Fax: 3-7-7 E-mail: -T1}t_ WtlG I Fnv+ • l-rel_ Property Owner
Information Name Vf
l,j l lames t SSIu 1.61- S Street: -7
3 MI S S i u yd City, State
Zip: S Ct"- K J Phone:-L07-
33t-SyS Resident of
property? : l ', II
Contractor Information
Name V\,
V y- S Phone: c ' 01
Street: L
q A-cjt L_&ne Fax: y0 7 City, State
Zip: SG n jZr-8 (- L- 3a -7 7 / State License No.: E F U o l l (Q ArchitecVEngineer Information
Name: -7a'
0, e ' V'l • Q_t i,V- i- I Street: -7
U I-)-e C--d city, st,
Zip: )-)CA-6 -e eAA U F U 3 3 S Z 3 Phone: 3 /
3- OLC? ? - 1 -2 / Fax: 3
5 - 55-n - 11 c1 C' E-mail:
Bonding Company:
Mortgage Lender: Address: Address:
y.. ... fin. -
Ri1A bT
NFORMATION ` ! Building Permit
Square Footage:
No. of
Dwelling Units: Electrical W_
New Service -
No. of AMPS: Construction Type:
No. of Stories: Flood Zone:
Mechanical (Duct
layout required for new systems) D\-Q
Plumbing New
Construction -
No. of Fixtures: Fire Sprinkler/
Alarm X No. of heads: e V61
1/
Application is hereby rpade t$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. A NOTICE
OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. 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 of Florida
Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
Signaturc o Owner/Agent Date
ccN+4 b L
nt Owner/Agent's Narne
c of F"Y L. DUTCHER f
iuta'v Public - State of Florida
MY Comm. Expires Apr 10, 2015
Commission # EE 82500
Owner/Agent is Personally Known to Me or
Produced ID _ Type of D) b. 4 i r MY-C
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Signature of ContractooKgent Date
Pobe,rt :3. Sea fn v
Print Contractor/Aent's Name
a'INZKT&ER
Signat F • _ tp,fiFj*ubeic - State of FetlDibl%
V ' My Comm. Expires Apr 10. 20 55
Commission I EE 82500
Contractor/Agent is ( • Personally Known to Me or
Produced ID Type of ID
UTILITIES:
FIRE: ,
ASTE WATER:
UILDING:
Rev 11.08
Date:-ElDate:—Elbb I Business
or Project Name: Address:
City
of Sanford Building &
Fire Preventio6 Division Fire
Plan Review Service Fees Tel:
407.688.5050 Fax:
407.688.5051 Permit #:
0 — o Contact
Named-, , Contact Ph: D% 4aLin-
Review Information Sas--
Construction
C/o (,,,frFire Alarm )] Fire Sprinkler Hood Tank Paint Booth Total
Fees: . k 7,45 - OC> Sa
pl eILI yu;'d dx