HomeMy WebLinkAbout3905 Moores Station Rd 09-72//��^��,, CITY OF SANFORD PERMIT APPLICATION
Application #: (J - Submittal Date:
Job Address: 3Rb rnC)OCC -S 5iG_ht o V C1, Value of Work: $ Sab . Oc?
Parcel ID: 69- ap - 31 -300 - 0 L45o — cop0 Zoning: Historic District:
Description of Work: G6a/1QQln Q sc,rvfIuc Square Footage:
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Permit Type: Building ❑ Electrical l Mechanical ❑ Plumbing ❑ Fire Sprinkler /Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service - # of AMPS Addition/Alteration ❑ Change of Service /''r Temporary Pole ❑
Mechanical: Residential ❑ Non - Residential ❑
Plumbing/ New Commercial: # of Fixtures
Replacement ❑ New ❑ (Duct Layout & Energy Cale. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing /New Residential: # of Water Closets
Occupancy Type: Residential ❑ Commercial ❑
Industrial ❑
Construction Type: # of Stories: # of Dwelling Units:
Plumbing Repair -Residential ❑ Commercial ❑
Occupancy Use Group(s):
Flood Zone: (FEMA form required)
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Property Owner:..JC�n tr r.a♦ N r QW A- CSU ort � Contractor: 0106e_ Lyr %do_C _A zA-
Address: I0100 GG 4 Address: 1Z 06 Q,,�
�anVbrcj r-Q 3a -7 -7 3
Phone: 407 z/ n/E- mail: �QVI YO 0SQ0 • ele _ Phone: State License Number: rC iii 13 01-6100 Bonding Company: jU .4 Mortgage Lender: _,kj
Address:
Address:
Architect/Engineer: /U I /"r Phone:
Address:
Plan Review Contact Person:
Phone: Fax:
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. 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 perm' is verification that wi 1 notify the owner of the property of the requirements of -F rids Lien Law, FS 713.
Sig ture of Owner /Agent Date� Signature o ntractor/ ent �te
P wi r /Age ' Name Print o irk tor/ gent's Name
Signature of otary-State offro—, a ""-- ----- Signature of Notary-State of Florida Date
3d;�j,0.Y YV
PHYLLIS I. GIBSON
' "e' MY COMMISSION #DDQ77598 PHYLLIS I. GIBSON
14' EXPIRES: OCT 02, 2009 MY COMMISSION #DD477598
t °, "O Bonded through 1st State Insurance EXPIR�E�S�:, �OCT 02, 2009
Owner /Agent is _ ersonally Known to Me or ConttactO AM i� thiti4rl 6fs2�7i&IUWR to Me or
Produced ID P'ro'duce t
APPROVALS: ZONING: UTIL: FD: ENG: BLDG:
Special Conditions:
Rev 02/2007 � ��