HomeMy WebLinkAbout115 E 21 St 03-2238 HVACCITY. OF SANFORD PERMIT -APPLICATION t i
Permit # : C'1 Date y.:
Job Address: . l
Description of Work: I j
Historic District: Zoning: Value of Work: $
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool.
Electrical: New Service — # of AMPS Addition/Alteration t1_
11
Change of Service Temporary Pole .
Mechanical: Residential _Non -Residential Replacement New (Duct Layout & 13nergy Ca1F_ Required) l,_
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 Tyne: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Contractor Name &
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Attach Proof of Ownership & Legal Description)
Phone:
State License Number:
Contact Person: Phone:3j 3_ /
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. t 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 rogaa,Ling
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR, PA, ] NG
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 «fII notify the owner of the property of the require nts of Florida Lien La FS 71
j Ad AVC0
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Ao
Print Owner/Agent's Name Pri ontractor Agent' ame
Signature of Notary -State of Florida Date tena P PCB No t}f XI RAVE Date
MY COMMISSION # DD 164280
EXP ovember 12, 2006
Oicesner/Agent is Personalh no n ro Vle or Con[Fa fl r':g4°d 7 rul c onaary hnKnown to Me or
Produced ID Produces :7
APPLICA-I ION APPROVED BY: Bldg:
Initial & Date)
Specia! Conditions:
Zoning:
Initial & Date)
I D: _ —
Initial & Date) (Irwial & Dat.