HomeMy WebLinkAbout1566 French Ave 09-295 HVACCITY OF SANFORD PERMIT APPLICATION
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Application #: � � �� Submittal Date: �/
Job Address: 15&6, F�+teN ✓�. Value of Work: $ Z 9 De, 00
Parcel ID: Toning: Historic District:
Description of Work: fe fi�i2•f%N�6642 ') 929lt1Q, UN I i" Square Footage:
Permit Type: Building ❑ Electrical ❑ Mechanicalg Plumbing ❑ Fire Sprinkler /Alarm ❑ Pool ❑ Sigtt ❑
Electrical: New Service - # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary'Pole ❑
Mechanical: Residential ❑ Non - Residential CK Replacement X New ❑ (Duct Layout & Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Litres
Plumbing(New Residential: # of Water Closets Plumbing Repair - Residential ❑ Commercial ❑
Occupancy Type: Residential ❑ Commercial DC Industrial ❑ Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required
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Property Owner: ?Aq-r Y J-A4K so 1 Contractor: Ru d V t1l veiny
Address: I rG (lo FXeti e-4 A V k Address: r O 19 B k 4 6
Phone:
Bonding Company:
Address:
E -mail: Phone *7 4q7 (OwState License Number: U¢401o'44CL
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
Plan Review Contact Person:
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. l understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, l [EATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: l 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 r s of F a Lien Law. FS 713.
SignatureofOwner /Agent Date S, re ofContractor /Agent Date
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Print Owner /Agent's Name Print Contract r /Agent's Name
Signature of Notary-State of Florida Date Signature of NotiU4§rZg*UIyr rD�d } - ¢. - y r
2otNiY PI'¢,c; .1 irr ItA t .O1s111
MY CO vIM[SSION ft DD629096
EXPIRES- February 25, 2011
Fl. Not Discount Assn. Co.
1- 8W.3-NOTARY
Owner /Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
UTIL: FD:
Contractor /Agent is Personally Known to M4017
_ Produced ID 0
ENG: BLDG:
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