Fire Permit Application

CITY OF LAKE MARY
FIRE PERMIT APPLICATION

FAILURE TO COMPLY WITH THE MECHANIC’S LIEN LAW CAN RESULT IN THE PROPERTY
OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS.
 
DATE SUBMITTED:_____________ RECV’D BY:_______________ PERMIT#:_________________________

PROJECT INFORMATION 
 
PROJECT NAME: ____________________________________________________________________________
 
PROJECT ADDRESS:__________________________________________________ SUITE #:______________
 
(FEE SIMPLE) OWNER:_______________________________________________________
 
CITY, STATE, ZIP:_____________________________________________________________
 
COMMERCIAL (     ) RESIDENTIAL (     ) # OF STORIES:_______ # OF UNITS:_______
 
SQUARE FOOTAGE:________________
 

CONTACT INFORMATION
 

CONTRACTOR:________________________________________________________                                                                                       

ADDRESS:_____________________________________________________________                                                                                        

CITY, STATE, ZIP:______________________________________________________            

PHONE #:_______________________________ FAX#:________________________             

E-MAIL:________________________________________________________________                                                                                        

 

LICENSE HOLDER:_____________________________________________________                                                                                        

STATE LICENSE#:_____________________________EXPIRES:_______________

CITY, STATE, ZIP:______________________________________________________            

PHONE #:____________________________ FAX#:___________________________             

E-MAIL:________________________________________________________________                                                                                          


WORK DESCRIPTION
(CHECK ALL THAT APPLY)
 
Work Description Check List
_____     NEW COMMERCIAL SHELL_____     FIRE SPRINKLER SYSTEM
_____     COMMERCIAL BUILD OUT_____     FIRE ALARM SYSTEM
_____     COMMERCIAL ALTERATION_____     HOOD SUPPRESSION
_____     NEW MULTI-FAMILY_____     UNDERGOUND FIRE MAIN
_____     NEW SINGLE FAMILY DWELLING_____     CLEAN AGENT
_____     RESIDENTIAL ADDITION_____     ACCESS CONTROL
_____     OTHER 

DESCRIPTION OF WORK:___________________________________________________________________

COST OF CONSTRUCTION: $_______________________________________________________________

Application is hereby made to obtain a permit to do work and installations as indicated;
State Law requires construction to be performed by licensed contractors. I certify 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 other work to be
performed.

NOTE: Any commercial or residential building undergoing a change of use of the
property will require a site plan review and approval prior to issuance of a Building
Permit.  Agencies that enforce building codes are required to state, additional
permits may be required from other governmental entities, such as Water
Management Districts, State Agencies or Federal Agencies as required by State
and Federal law.
 

________________________________________________
               Owner/Agent (Please Print)

________________________________________________
               Owner/Agent (Please Sign)
 
STATE OF FLORIDA
COUNTY OF SEMINOLE

The foregoing instrument was acknowledged before me this _________ day of ________
20______ By ___________________________________ Who is personally known to me
and /or has produced _______________________________________________ as
identification and who did (did not) take an oath.
 
 
_____________________________________                     (SEAL)
           Notary Public Signature
 
______________________________________
         Notary Public Print Name
 
 

________________________________________________
                  Contractor (Please Print)

________________________________________________
                  Contractor (Please Sign)
 
STATE OF FLORIDA
COUNTY OF SEMINOLE

The foregoing instrument was acknowledged before me this _________ day of ________
20______ By ___________________________________ Who is personally known to me
and /or has produced _______________________________________________ as
identification and who did (did not) take an oath.
 
 
_____________________________________                     (SEAL)
           Notary Public Signature
 
______________________________________
         Notary Public Print Name
 
OFFICIAL USE ONLY

                                     Date                    Initial                                     Comments
 
Fire Department ____________    _______________  ________________________________________
 
_______________________________________________________________________________________