3609 N Orlando Ave Ste 200 - BC01-002479 (FIRE SPRINKLER) DOCUMENTS174-79CITY
OF SANFORD PERMIT
APPLICATIONPermitNo.: Q I Date: 'J`(fi
Job Address: "YAQ (9RJA J tk) avt 2,0 0
Parcel No.:
Description of Work: SDOy4 4,an aP
Attach Proof of Ownership & Legal Description)
Type of Construction: Flood Zone:
Valuation of Work: $ -7,& Occupancy Type: Residential / Commercial Industrial
Number of Stories: Number of Dwelling Units: Zoning: Total Square Footage:
Owner:-trytf'.ua
Address: I1
City:S\
Phone No.:0 3010
Contractor: ; utka
Address: `1901
City: -,5AORODd
State: \-- Zip:
FaxNo.:
State: P. Zip: 7e7'71 State License No.: 09'Z!57 p'Jna()1 r
Phone No.: ,(qT)t0?T- 1)q xsaoy, Fax No.: (4011 tab ff-' 43 `
Contact Person: nt g k., A-, Phone No.: 40- (,Xf-1 ` 44 ,X 3 et9l
Title Holder (If other than Owner):
Address:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect: Phone No.:
Address: Fax No.:
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 1
t
Signa of Owner/ gen Date
rint Owner/ is Name\,, \
Signatur of otary- tate of I ,— Date x
erZ,,, BRENDA L FAMARTiNQ
a NOT"R``iit* my Coenrn Fxp. U.A
w PUFS'.iCft' No, CC 4001.•
Owner/Agent is /Personally Known to Me or
Produced ID
fatly ,Yv i n
Print Contractor/Agent's Name
ign t otary-State of Florida Date
Mary Leathers
t My Commission CC950743
Expires June 28, 2004
Contractor/Agent is V<sonally Known to Me or
Produced ID
APPLICATION APPROVED BY:
Special Conditions:
Date: l G
CITY OF SANFORD FIRE DEPARTMENT
FEES FOR SERVICES
PHONE # 407-302-1091` * FAX #: 407-330-5677
DATER I PERMIT #:
BUSINESS NAME / PROJECT:
ADDRE'
PHONE
CONST. INSP. [ ] C / O INSP.:[ ] REINSPECTION [ ] PLANS REVIEWF. A. [ 1 F.S. [ ] HOOD [ ] PAINT BOOTH [ ] BURN PE I [ J
TENT PERMIT [ J TANK PERMIT [ ] OTHER [ ]
TOTAL FEES: $E ' OO (PER UNIT SEE BELOW)
COMMENTS:
Address / Bldg. # 1 Unit # Square Footasze Fees per Bldg / Unit
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12. _
13.
14.
15.
16.
17.
18.
19.
20.
Fees must be paid to Sanford Building Department, 300 N. Park Ave., Sanford, FI. 32771 Phone # -407-
330-5656. Proof of Payment must be made to Fire Prevention division before any further services can take
place. I certify that the above is true and correct and that I
will comply with all applicable codes and ordinances
of the City of Sanford, Florida.
C),,,
Sanford Fire Prevention Di i ' n Ap icant's Signature
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Sanford
F Date:
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iZ a0unel , ypty RECEIVED
SEP
0 7 2001 INSTALLED
BY: Mai
SOUTHEAST
FIRE
SPRINKLERS,INC. 8801
W. AIRPORT 9LVD SANFORD
FLORIDA PHONE (
407) 088-1949
Y1
FINAL INSPECTION REQUIRED
3t 0`1 0 ly L.'A bl,
SANFORD BUILDING DEPT.
THESE %ANS ARE REV'EWED AND CONDITIONALLY
ACCEPTED FOR Pr_RMIT A PERMIT ISSUED SHALL BE
CONSTRUFD TO BE A LICENSE TO FROCEED WITH
THE WORK AND NOT AS AU FHORITY TO VIOLATE,
CANCEL. ALTER. OR SIFT ASIDE ANY OF THE
PROVISIOI`43 OF THE TECHNICAL CODES, NOR SHALL
ISSUANCE OF A PERMIT PREVENT THE BUILDING
DEPT FROM THEREAFTER REQUIRING A CORREC-
TION OF ERRORS ON THE PLANS, CONSTRUCTION
OR OTHER VIOLATIONS OF THE CODES.
lo.;1401S
ol • a 479
If -
OFFICE COPY