HomeMy WebLinkAbout1901 WP Ball Blvd 04-2565 (mech)CITY OF SANFORD PERMIT APPLICATION
Permit # :_(, i
Job Address: )J
Description of Work:
Historic District: Zoning: Value of Work:
Date: 1 0a., 3 C) r U i
Permit Type: Building Electrical Mechanical 2 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)
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Phone: ^
Contractor Name & Address: air y cyret Z y\ 1'' LJC0 "'i S o1-\ ±!5 — /! G
State License Number:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer.
Address:
Contact Person: Phone:
Phone:
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 of all 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: 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 verification that 1 will notify the owner of the property of the equir ents of Florida Lie Law, FS 713.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg: Zoning:
Initial & Date)
Special Conditions:
rit ntractor/Agens C
rb€No\
1/'
PFWAWAVC \)
oDl
ate
I
MY COMMISSION I DD 164280
EXPIRES: November 12, 2006
lF do SondM Thm Budget Notary Services
Copptrni r/Agent Personally own q Mee pr
Produced ID L \ . d l
Utilities: FD:
Initial & Date) (Initial & Date) (Initial & Date)
12/30/04 02842pm P. 006
SibJ
7
CITY OF SANFORD PERMIT APPLICATION
Permit# : ny- "1 65 Date:
Job Address-1(U d
Dotcription of work
Historic Altttrict: Zoning; Value of Work: S L . b—()—D
Permit Type: Building Electrical Mecbanical —X— Plumbing Fire Spain)dvr/Alarm Pool
ElecWcW: New Service —# of AMPS Addition/Alteration (.-hange of Scrvico Temporary Pole
Mechanical: Residential Non-Rosidential Replacement Ncw (Duct Layout & Energy Cale. Roquired)
plumbing/ New Commercial: # of Fixtures of Water & Sewer Lines # of Gas Lines
Plumbing/Now Residential; # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commcrcial industrial Total Square Fo
Construction Type: #'of Stories: of Dwelling Units: blood Zone: _ _ (VEMA form regaircd for otber than X)
Parcel #:
Owners Name A Address:
Pboao
AUaeh Proof of Ownership A Logan Desctipdm)
Phone:
Bonding Company:
Address:
MorgCago lender.
Addrar
AmbitaVBogloeer. Phone:
Addrom Fart:
Application in hereby made to obtain a permit to do the work and instalbdions as indicated, 1 certify that no work or installation has commenced prior to the
issuance of o permit and that all wont will be parornred to meet standards of ail taws regulating construction in this jurisdiction. 1 understand that a separate
permit mutt be secured for ELECTRICAL WORK, PLUMBING, SIGNS. WE1,i.S, POOLS, MRNACRS, BOILERS, HRATERSJANKS, and
AIR CONUITIVNtA& ett,
OWNHR'S AFFIDbVIT: i ocn* that oil ofthe foregoing i+llbtrnation is accuraw and that all work will be done in compliance with all applicable laws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD n NOTICE OF CUMMFNCBMUNT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING. CONSULT WITH YOUR LENDER OR AN
A'fTORNRY BBFORB XECUKVING YOUR NOTICE OF COMMENCBMBrff.
TIC : in addition to the requirements ofthis permit; them may bo odditional restrictions applicable to this property drat may be found in the public records of
this county, and there may be additional permint required from other govemmenral entities Much as water management districts, etato agencies, or federal agenda.
Acceptance ofpermit is verification that I will notify the owner of the property of the equf s of Florida Lic aw, FS 713.
Ar.c n S 40Ll
Sigoaun of 0wr a/Agent Date Signature ofContractor/Agent Date
Print Owner/Agent's Name
Signature ofNotarystateofFlorida Date
Ownet/Age nt is _ Personally Known to Me or
Produced ID _
APPLICATION APPROVED BY: Bldg Zoning:
Inldal A Date)
Special Conditions:
Initial A Date)
ntractodAgcay7C ta ) ,l•w
N Dare
My MOISSION I oD 164280
EXPIRES: November 12, 2008
b0* Thn BsdpO1 *WY SatviwsAti . Personally norm Mc rProducedl0k%! e j
Utilities: VD:
initial A Dale) (Initia) A Date)
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