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Home My WebLink About1007 Palmetto Ave 04-378 Garage DemoCITY OF SANFORD PERMIT APPLICATION Permit # : d V Date: Job Address: lb In, 'OV4l .+ t r 1v .f4-L Description of Work: /i eV1.10 i a`C s Historic District: ly /-_I Zoning: Value of Work: $ 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 -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 INIO Commercial Industrial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than x) Parcel #: Attach Proof of Ownership & Legal Description) Owners Name & Address: 11--el le_ !A /-/L el---r £4-f V--C"t A', k- L ? r% ' Phone: (2D Contractor Name & Address: State License Number: Phone & Fax: Contact Person: Bonding Company: Address: Mortgage Lender: Address: Architect/ Engineer: Phone: Address: 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 verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. Si nature of Owner/Agent Date Signature of Contractor/Agent Date na&, n Sign e t Vu fy-StfE ill , DE GRAVE Date r MY COMMISSION # DO 164280 EXPIRES: November 12, 2006 w e°e onded Th 6tt Notary Services Oer/Agents- 0 PersonN Known to Mg oc roduced ID 3 0 ` e" `{ l APPLICATION APPROVED BY: Bldg: Zoning: tial & Date) . Special Conditions: Print Contractor/Agent's Name Signature of Notary -State of Florida Date Contractor/ Agent is _ Personally Known to Me or Produced ID Initial & Date) Utilities: FD: Initial & Date) (Initial & Date) 33o)-S`1 DEMOLITION Building Division Acknowledgement A. Permit Application B. State Forms C. State Statutes/Contractor Licensing Public Works Acknowledgement A. Sidewalk Closing B. Street Use/Closing 1. Walkways — Protection — Width 2. Barricades — Protection — Width 3. Fencing — Protection — Width - Height 4. Curb Protection/Sidewalk Protection/Street S. Storm Sewer Protection C,: l ugt Control .. Police Department Acknowledgement A. Traffic Control B. Crowd Control/Security Utility Department Acknowledgement A. Water, Sewer — Capped off, Sealed B. Water for Dust Control (Meter) Engineering & Planning Acknowledgement A. Historic District B. Zoning Issues Ad&ess`of Job: .i7 Additional Comments: ate DEMOLITION Building Division Acknowledgement A. Permit Application B. State Forms C. State Statutes/Contractor Licensing Public Works Acknowledgement I "? LJ'%'r U'' A. Sidewalk Closing B. Street Use/Closing I . Walkways — Protection — Width 2. Barricades — Protection — Width 3. Fencing — Protection — Width - Height 4. Curb Protection/Sidewalk Protection/Street 5. Storm Sewer Protection C, ' Dust Cohtrot .. Police Department Acknowledgement A.. Traffic Control B. Crowd Controf/Security Utility Department Acknowledgement A. Water, Sewer — Capped off, Sealed B. Water for Dust Control (Meter) Engineering & Planning Acknowledgement A. Historic District B. Zoning Issues Address of Job. - Additional Comments: 1. 11/12/2003 08:49 4073022540 SANFORD PD 1 1 -1 1 -20.3 7 : 4GAIA FROM V PAGE 01 Building Division Acknowledgement A. Permit Application 13. State Form; C. State Statutes/Contractor Licensing Public Works Acknowledgement A. Sidewalk Cicsing B. Street Use/Closing 1- Walkways - Protection - Width 2. Barricades - Protection - Width 3. Fencing Protection - Width - Height 4. Curb Protection/Sidewalk Protection/Street 51_ Storm Sewer Protection DYr_ ust.Cotarol Police Department Acknowledgement A.. Traffie Control Crowd Control/Sewrity Utility Department Acknowledgement A. Water. Sewer- Capped off, Sealed B Water for Dint Control (Meter) Engineeting & Planning Acknowledgement A. Historic District B. Zoning Issues Address of Job' Addit:onai Commeri DEMOLITION Building Division Acknowledgement A. Permit Application B. State Forms C. State Statutes/Contractor Licensing Public Works Acknowledgement A. Sidewalk Closing B. Street Use/Closing 1. Walkways — Protection — Width 2. Barricades — Protection — Width 3. Fencing — Protection — Width - Height 4. Curb Protection/Sidewalk Protection/Street 5. Storm Sewer Protection C: 'Qust.Coritrol Police Department Acknowledgement A. Traffic Control B. Crowd ControUSecurity Utility Department Acknowledgement A. Water, Sewer — Capped off, Sealed B. Water for Dust Control (Meter) Engineering & Planning Acknowledgement A. Historic District B. Zoning Issues Address of Job: Additional Comments: 1. DEMOLITION Building Division Acknowledgement A. Permit Application B. State Forms C. State Statutes/Contractor Licensing Public Works Acknowledgement A. Sidewalk Closing B. Street Use/Closing l . Walkways — Protection — Width 2. Barricades — Protection — Width 3. Fencing — Protection — Width - Height 4. Curb Protection/Sidewalk Protection/Street S. Storm Sewer Protection Pu$t,Coritrol .. Police Department Acknowledgement A. Traffic Control B. Crowd ControlJSecurity Utility Department Acknowledgement A. Water, Sewer — Capped off, Sealed B. Water for Dust Control (Meter) Engineering & Planning Acknowledgement A. Historic District B. Zoning Issues L Address of Job: Additional Comments: