HomeMy WebLinkAbout2451 Old Lake Mary Rd 08-2295CITY OF SANFORD PERMIT APPLICATION (�
Application #: 08 _2,z9� Submittal Date:
Job Address: G&S_/ COLD 4,44, �E /96 1( 40 Z Value of Work: S
Parcel ID
Zoning:
Historic District:
Description of Work: AZ-W PLCYA(A -7- /(/(r Square Footage:
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Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing J< Fire SprinkledAlarm ❑ Pool ❑ Sign ❑
Electrical: New Service - t4 of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non- Residential ❑ Replacement ❑ New ❑ (Duct Layout & Enemy Calc. Required)
Plumbing/ New Commercial: K of Fixtures -/—(:7—> ## of Walr & Set er Lines n of Gas Lines
Plumbing/New Residential: » of Water Closets Plumbing Repair -Residential ❑ Commercial ❑
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: _ d of Stories: r of Dwelling Units: Flood Zone: (FE:NIA form required)
Property Owner: Contractor: e7 I-IZ6 /19 (; TD✓ 6,
Address: Address: 4-3a A 99i114/
2 /
Phone: E -mail: -•— Phone: State License Number: 0FC'6U, -/9
Bonding Company:
Address:
Arch itect/Engmeer:
Address:
Plan Review Contact Person:
tMortgage 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 WORE, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS. TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: t certify that all of the toregoing intormation 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 I-OR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCENIEN'T NIUST 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 COiv4MENCE,,4L'N "C
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 penults 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 F onda Lien Law, FS 7l 3_ 9
Signature of Owner /Agent Date Sin of Con ractor /Agent Date
Print Owner /Agent's Namc
Signature of Notary-State of Florida Date
Owner /Agent is
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 0 7.0 7
Personally Known to Ivte or
UTIL:
FD:
PnEz!�i's Name
Signature of Notary-State of Florida Date
K• tt' ll' Cf s °lla'aION # DD629096
Eiji 1RC_3i February 25, 2011
vu; =! :�'OT,�i1• Ft. tJ014Y Discount Assx. Cc.
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Contractor Agent rs 'rMS2fi��lj°l�ir c r
Produced ID
LNG: BLDG: