HomeMy WebLinkAbout1208 W 9th St 09-424 Demo SFHCITY OF SANFORD PERMIT APPLICATION
Application #: / llJ +, _ Submittal Date: _
Job Address: Ul%� Y Y
Parcel ID: Zoning: Historic District:
Description of Work: d �l 1- Square Footage: ODD
.......................................................................................... ...............................
Permit Type: Building ` Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alami ❑ Pool ❑ Sign ❑
Electrical: New Service - # of AMPS _ AdditioniAlteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non - Residential ❑ Replacement ❑ New ❑ (Duct Layout & Energy, Cale. Required)
Plumbing/ New Commercial # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑
Plumbing Repair -Residential ❑ Commercial ❑
Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FENiA form required)
• )... I ..................... .x. 'L..6' /..��......ICC C. ...
Property Owner: Seylc_4'(fL � Contractor 424
Address: �9� o tN - �/ S .T Address: d �
Phone: E -mail: Phone:76' 7',/ ' irk State License Number:
Bonding Company:
Address
Architect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Leader:
Address:
Phone:
Fax:
Phone: Fax:
E -mail:
Application is hereby made to obtain a pemt 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 iG fO OWNER: YOUR FAILURE rO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING I-WICE FOR
EMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE TIIF.
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 propert of the�req tints of Florida Lien Law, FS 713.
17
Signature of Owner /Agent Date Sh6aturc;/ofContractorrAgeni Date
Print Owner/Agent's Name
Signature of Notary-State of Florida Date
Owner /Agent is _
Produced (D
APPROVALS: ZONING:
Personally Known to Me or
UTIL
Pri n tor/ ent's Name
1 / - v
Si nature of Notary -State of Florida Date
Contractor/Agent is _
Produced ID
FD: ENG
Personally Known to Me or
BLDG:
Special Conditions:
Rev 07.07 \