HomeMy WebLinkAbout1300 Central Park Dr 09-410 HVACCITY OF SANFORD PERMIT APPLICATION
09 — —{ 10
Permit # :
Date:
Job Address: �(�l� l ErLk r2
Description of Work: (' , it �o tR ��
�C_ C� +nt✓ �1 e�� )G �4 C k -1%L (3 A A �
Historic District: J_ Zoning-
Value of Work: $,%s (12 ��, 00
Permit Type: Building Electrical
Mechanical Plumbing Fire Sprinkler /Alarm Pool
Electrical: New Service — # of AMPS
Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non - Reside
Replacement -N/ New (Duct Layout & Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures
# of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets
Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial
Industrial Total Square Footage:
Construction Type: # of Stories:
# of Dwelling Units: Flood Zone: (FEMA form required for atfter thzn x)
Parcel #: 7-5-19— ;�p — . JT 6— 1 -Tri- [ e, 2 (Attach Proof of Ownership ,& Legal Description)
Owners Name & Address: r f �4-�t y "�+� -1 r1�2 c�� i� • �X l � i� t�'(rf
Phone:
Nam e & Address:
}y 1
3
Phone AFax: Y(P- �SS Contact Person:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
State License Number:
Phone:
Fax:
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 lawa regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PA.i')NG
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 5aybe found in the public records of
this county, and there may be additional permits required from other governmental entities such as water management di5rrr99, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirement of FJ brida Vn4LaX,, FS 713.
Signature of Owner /Agent
Print Owner /Agent's Name
Signature of Notary-State of Florida
Owner /Agent is _ Personally Known to Me or
_ Produced ID
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Date
Date
Print Contractor /Agent's Name/
Date ignature < ota tale of Flori Date
Contractor /Agent is 7Z Personally Known to Me or
Produced ID
Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date)
cam" Psi ; BRANDY 9 NOY
MY GXPIR ES I Oe obe 08, 2019