HomeMy WebLinkAbout2011-2071 WP Ball Blvd 05-932 (fr sp)CITY OF SANFORD PERMIT APPLICATION
Permit # : " 7
n .
Date: / 2--
Job Address: —D /l --0 i r' /it/ - /' p o/,/
Description of Work: Zivs7-4jZ -4—
Historic District: Zoning: Value of Work:
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Ahm Pool
Electrical: New Service — # ofAMPS Addition/Alteration 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 # ofGras 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 M (Attach Proof of Ownership & Legal Descriptiou)
Owners Name & Address: / lai._i / 4r
Bonding Company.
Address:
Mortgage Leader:
Address:
Arcbitect/Engineer. — Phone:
Address: Fax:
Application is hereby made to obtain a perms[ to'd67t ie work and tnstallatiorls as m icated. 1 Maioo work or installation has commenced prior to theissuanceofapermitandthatallworkwiUbermedtomeetstandardsofalllawsregulatingrconsauctwointhisjurisdiction. 1 understand that a separate
permit must be secured for ELECTRICAL: RMW-+L INGytS L , Fd k61 BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc. +
OWNER'S AFFIDAVIT: I certify that all ofihe.ttorcgoin in i all wontwil done in compliance with all applicable laws regulating
construction and zoning. WARNING TO OWNER YOUR FAI O OTICE OF - MENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINAN , 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 property of the rcquiremen Fl da Lie Law, FS 3
L (41 a,f
lft Signature ofOwner/Agent Date Signature of C ntractor/Agent Date
Print Owner/Agent's Name
Signature ofNotary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg: Z ?—O fining:
Initial & Date)
Special Conditions:
7
Print tractor/Agent's NameneSignature
of Notary -State of Florida Date.LMDAL. PHILLIPS` No
yytaryPUbliC, State of Florida Contractor/
Agent is Personally Known MMe ormm. exp. Sept. 29, 2006 Produced
ID Omm. No. DD 1 4192 Utilities:
FD:. Initial &
Date) (Initial & Date) l nitial & D'aie)