HomeMy WebLinkAbout115 Oaks Ct 04-269 HVACCITY, OF SANFORD PERMIT APPLICATION
Permit # :
C—
v Date: 1
Job Address: S0c,
Description of Work: Q iS l/VL -
16
Historic District: 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 A 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 _ Q— Commercial Industrial Total Square Footage: A,C q Q
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 33 14 - 0 (Attach Proof of Ownership & Legal Description)
Owners Name & Address: 2 y,%cA (A
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I Phon e (1S l CS SGan 3a? -0-z
Contractor Name & Address:
C14 Q0%M%nkRt V1 gv2i i
3aZura.st aLicenseNumber: Q<
Phone & Fax:
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3 21zlp 'j on: Contact PerskFil r Phone: ______ Bonding
Company: wk Address: _
Mortgage
Lender: Address:
Architect/
Engineer: WAS 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 n compli ce with all applicable laws regulating construction
and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMM CEME MAY RESULT IN YOUR 11 )'7td TWICE
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, C NSULT ITH 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 a l ble thiss p that may J-undin the p 7 records of this
county, and there may be additional permits required from other governmental entities ch as w er rp6n ment dis ts, s to agencies, federal agencies. Acceptance
of permit is verification that I will notify the owner of the property of Signature
of Owner/Agent Date Print
Owner/Agent's Name Signature
of Notary -State of Florida Date Owner/
Agent is Personall% Known to Me or Produced
ID APPI_
ICA1 ION APPROVED BY: Bldg: Zoning: Initial &
Date) Special
Conditions: lire
nts F da Lie w, FS 7 Iy/
0'A ature
of Contractor/Agent Date ROBERT
G. DELLO RUSSO Print
Contractor/Agent's Nam q*,
Signature
of Notary -State of trionua Contractor/
Agent is rpc"onally Known to Me or Produced
ID Initial &
Date) C `:
hies: FD: Initial &
Date) (Initial & Date) D,
4Y rpMMi$SION # DD 212893 June
14, 2007 cv
e: AdBonded 1'hru iJotary Puhlic Underwriters