HomeMy WebLinkAbout1551 WP Ball Blvd 004-2566 (mech)CITY OF SANFORD PERMIT APPLICATION
Permit # : V (4 - as 6b
Job Address: 159 I w11 -P JGJ
Description of Work: H I
Historic District: Zoning:
Date: IOC 3 d — V 7
Value of Work: S 19 3. d u
Permit Type: Building Electrical Mechanical A_ Plumbing Fire Sprinkler/Alarm Pool
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 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 other than X)
Parcel #:
Owners Name & Address:
Attach Proof of Ownership & Legal Description)
Phone:
Contractor Name & Address:, tt, 1 I o h A -_ ar r i S o n ( U+ C
State License Number:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Contact Person: Phone:
Address:
Architect/Engineer: Phone:
Address: Fax:
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 ofall laws regulating construction in this jurisdiction. 1 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: 1 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 ofthis 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 1 will notify the owner of the property of the re Creme is of Florida Lien Law, FS 713.
Signature of Owner/Agent Date nature of Contract Agent Date
Print Owner/Agent's Name P 'nt ontractor/Agent's 4am ,
qjalc
Signature of Notary -State of Florida Date of Notary -State of Florida Date
r0 .•••. FLORENCE A. DE GRAVE
a , MY COMMISSION # DD 164280
EXPIRES: November 12, 2006
Owner/Agent is _Personally Known to Me or C ' tdcedID ApaJ{,149 IV Mnor
Produced ID Produced ID '3 (el Z` e
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions:
Zoning:
Initial & Date)
Utilities: FD:
initial & Date) (Initial & Date)
i
12/30/04 OZ:4Zpm P. 008
r/
Permit 0 : i
Job Address,
R- 3
CiTY OF SANFORD PERMiT APPLICATION
Description of Work: rn c_z&% fl TR . T/ L•
ERstoric District: Zoning:
Date: I k— 3 d- 0 q
Permit Type: Building Electrical Mechanical __X_ Plumbing Fire Sprinkler/Alarm Pool
Electrical: Now Service — 0 ofAMPS Addition/Altration __ Change of Service Temporary Pole
Mechanical: Residential Non -Residential RwIammcmt—_New (Duct Layout & Tsnergy Cale. Acquired)
Plumbing/ New Commercial: M of Pixture5 M ofWater & Sewer Linea k of Gas Lines
PlumbinglNew, Residential: d of Water Closets Plumbing Repair — Residential or Commmial
Occupancy Type: Residential . Commercial ToduArial Total Square loot e:
Construction Type: p of Stories: # of Dwelling ()nits., )Flood Zone. (FP.MA form rogtdred for other than X)
Parcel s: — (Attitct: P(rloot of Oaeership & Legal Description) .
OwMrs Namedi Address Y j Phone:
Address:
Mortgage
Lender. Adduce.:
ArebitecMug
wer' Phase: Address.
Fax: Application
I% hereby made to obtain a permit to do the work and installations as indicated. i certify that no wort or installation has commencedprior to the issuance
of a permit and that ail work will be performed to meet standurds of alllaws regulating construction In this jurisdiction. i understand that a separate permit
most be secured for ELECTRICAL WORK, PLUMBLNG, SIGNS, WELLS, POOLS, FURNACES, ROU-ERS, HEATERS, TANKS, and AIR
CONDITIONERS. ctc. O
WS AFFiD&Yrr I entity that all of the foregoing information u accurate and that all work will be done in compliance with all applicable laws rcltulatin` construction
and nmaiog. WARNING TO OWNER: YOUR FAILURP. TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT iN YOUR PAYING TWMV
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT ATM YOUR LENDER Olt AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMML•'NCRML'NT. NOTIC11-
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 endues such as water management districts, stele agencies, or fedeml ageacio. Acceptance
of permit is vaifieatioa that I will notify the owner of the property of the Signature
of Owner/Agent Date Print
Owner/Agent's Name Signature
of Notary-Stato of FloridaDate Owns/
Agent is _ Pe:rscoally Known to Me or produced
ID of
FloridaLlcn Law, PS 713. J.
I >,o Cq. FLORENCE
A, DE GRAVE Mil'
COWIIISSICN d DD1M280 C
EXPIRES: November 1 , 2QD@ ly
or Produced
ID _ rc.i_ APPLICATION
APPROVP.D BY: Bldg: Zoning _ Utifities: VD: initial &
Date) (Initial tit Data) (initial & Date) (initial eft Date) Special
Conditions: Q,
YMA'+.:,1 v,Y:.. i J <.'+:%L'r'w'1.' . : r.. + . ,7., . _ _