HomeMy WebLinkAbout1800 French Ave 09-548 (fuel disp)Z f8 ,s �7
CITY OF SANFORD PERMIT APPLICATION
Permit #: d"l" E`JS Date:__
JobAddress� 1 boc S ; r -i2ct h-C-4 A e, SO 111 cJ71 -_ --
Description of Work: ICI► ° bt r Rev 160e, q - is t: il7cjvas ynil 71W) jAwr, {g�.it. Js tft,►t
Historic District: Zoning: Value of Work: S 7 I
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler /Alarm Pool
Electrical: New Service — # of AMPS AvklkiefYAlteration V 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 I # of Gas Lines
Plumbing/New Residential: # of Water Closets / Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial "i/ Industrial; Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 1t✓ 19 •3U yoe G a U t? (Attach Proof of Ownership & Legal Description)
Owners Name & Address: rte _ .3e, —n N LL
Contractor Name & Address:
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Phone & Fax: qu
Bonding Company:
Address:
Mortgage Lender:
Address:
Arch itect/Engineer:
Address:
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V Ll S Fi
r Fe- 3: 'A'f Phone:
State License Number: 1:G Uyy I � aed
Contact Person: LVi'L: SC,c:F UA Phone: .b 1 l%/%1 Li X4'1
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 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 permit is verifi lion h;
Si naturg o Owner /Agent
Print Owf/er /Agent's Name
Owner /Agent is N
_ Produced ID
APPLICATION APPROVED BY: Bldg:
Special Conditions:
I will notify the owner f the roperty of the require me is of Florida Lien Law, FS 713.
� �rl
ate Signature of Cot ctor /Agent Date
A � 11.,4 -�ocga 21 110 .o,(
Print Contracto Agent's Nam
i
'1 yy MWEA$EMISH nattire otary-State of °a l�8i� 0®
Noary P Inc - St�N of Flottda ,,1Pµ:' fib,, ANGELA PETTIT
6• MYCewftl t►E>rpi nJs 103p,ZpiZ ; i °, .`�': Notary Public -State of Florida
CouMaU11M 4 DD 753614 d + •= My Comm. Expires Nov 12, 2012
d r o X860 ntractor /Agent is Per ri@t J R ;to Me�mmission # DD 837993
Produced ID o: v °r`
Througri Nitional Notary Assn.
(Initial & Date)
Zoning:
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)