HomeMy WebLinkAbout204 Sanford Ave 08-2526CITY OF SANFORD PERMIT APPLICATION
Application #:
Job Address:,;
09 , -2- 5 2 ,
® C.+ �n / r11rG ✓
Submittal Date:
Value of Work: S
9/3/0,9
( S 0J I d I-)
Parcel ID:
Zoning:
Historic District:
Description of Work: k e ,t! ( P P 5' P,./V l C e Square Footage:
........................... / ....... • • ................................................ ...............................
Permit Type: Building ❑ Electricali Mechanical ❑ Plumbing ❑ Fire Sprinkler /Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service - # of AMPS s V�Q 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
Occupancy Type: Residential ❑ Commercial ❑
Construction Type: # of Stories:
Industrial ❑
# of Dwelling Units:
Plumbing Repair —Residential ❑ Commercial ❑
Occupancy Use Group(s):
Flood Zone: (FEMA form required)
............................. .... ........................................... � .` ..`.� . ....�. �C,Property Owner:: k/. Contractor
Address: 6 /" % AddressW I GN ,, �
L z t, e-
0 YF 2 av (a,J o f L 3.16 Id
Phone: Yfj 7 ° �' r 7Zv E -mail: Phone: G) y '4 6 State License Number: `l a `% Z% d
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person
Mortgage Lender:
Address:
Phone: Fax:
Phone:
Fax:
E -mail:
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. 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.
Signature of Owner /Agent Date Signature of ConAAtrnnactor /Agent Date
fre-l11 k J ►"1a�dMt$'vP1 )f 3t/0,2
Print Owner /Agent's Name Print Contractor /Agent's Na e
9-.3 09
Signature of Notary-State of Florida Date Ski%{ ature ofotary -State of Floridla Date
U dJ•, .s��n JOANt�RJOHNSON
* x MY COMMISSION # DD 761978
' I ^i EXPIRES: March 23, 2012
MOO Thru Budpt Notat 89*es
Owner /Agent is _
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
Personally Known to Me or
UTIL:
Conttac r /Agent is Persgpa 1(y Known to Me or
roduced ID {/(� (J c�
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