HomeMy WebLinkAbout401 W Seminole Blvd #247 09-339(�_
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j CITY OF SANFORD PERMIT APPLICATION
Application #: " (�/ r 3 ib Submittal Date:
Job Address'AA( Q I) )A A-7 Value of Work: S n
Parcel ID: ,�CG, 3Qh + 6070 � 0006 Zoning: Historic District:
Description of Work: i-t7-c.%lrtkA Square Footage:......... ............................... ............................... ............................... ........
Permit Type: Building O Electrical ❑ Mechanical Plumbing ❑ Fire Sprinkler /Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS 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 T e•_Residential ❑� Commercial ❑
Plumbing Repair— Residential ❑ Commercial ❑
Industrial ❑ Occupancy Use Group(s):
Construction Type: It of Stories: # of Dwelling Units:
Property Owner: 1rl
Address: JIOCCI '4"aoa cAcx3
Phone:22q ` 080 E -mail:
Bonding Company: /A
Address:
Flood Zone: (FEMA form required )
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...................... - - --
Contractor: • • , -p— •l `• • 1-t + (lr
Address: S 7�3 1' p(' jO d f> 06 � �)ll
Phone: d 1 2to6S State License Number( (kn 3a q\l P
Mortgage Lender:
Address:
Architect/Engineer: lv 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. 1 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 certiA, 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 AN POSTf D ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR ATTORNEY BEFIORE RECORDING YOUR
NOTICE OF COMMENCEMENT. �� /
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to thisyr6perty Kat may be foun6 in the public records of
this county, and there may be additional permits required from other governmental entities such as wat7n, geme tdistricts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property oGt of ments.of Florida ien Law, FS 13.
Signature of Owner /Agent Date i ure of Contractor /Agent uctiv
^4t_ T G. DELLO RUSSO
Print Owner /Agent's Name Print Contractor /Agent's Na
f0q
Signature of Notary -State of Florida Date Signature of Notary-State =INEF _ ..��-
TURNER # DD 667937 ne 14, 2011 Public Underwriters
Owner /Agent is _Personally Known to Me or Contractor /Agent is Personally Known to or
Produced ID Produced ID
APPROVALS: ZONING: UTIL: FD: ENG: - BLDG:
Special Conditions:
Rev 07.07
30 U ,or