HomeMy WebLinkAbout1317 W 12 St HVAC change outCITY OF SANFORD PERMIT APPLICATION
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Permit # :
Job Address:
Description of Work: VhA/!y_&,o
Historic District: Zoning:
Date: /D • & -p S q50,0
Value of Work:
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS __ Addition/Alteration Change of Service M Temporbiy Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cale. 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: 9M
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
n (
Attach Proof of Ownership & Legal Descriptioa)
Owners Name & Address: i/1%AL tn/iM CLL
229 MZe woe -%VW,50 rl 321r2 3 Phone: 409- 23 (-
Z5 ZZ 57 OVIiY Ae -96 l Wol CL State License Number:
Phone & Fax: ,7.i ? fG. '— 's(e2 Contact Person: J Gr y y Ja 4450 NJ Phone: —#0, -9_'3- Z! _Z._[5fi Z
Bonding Company
Address:
Mortgage Lender: _
Address:
Architect/Engineer:
Address:
Phone:
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 t1t
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 sf-Ty rate
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 Iaws regulai ng
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT l7q YOUR, PA.YWI(s
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 reuire qoriLaw, FS 13. Signature
of Owner/Agent Date Signature of Contr for/A nt Date 4 '
72.fCo 6 /A1 Print
Owner/Agent's Name PA..
tureontractor/
Agent's Name Xkk -
q Signature
of Notary -State of Florida Date of Notary -State of Florida Date Owner/
Agent is Personally Known to Me or Produced
ID AITLICA"
I-[ON APPROVLD BY: 1:31dg: Initial
k, Uate) Zoning:
o
fARBARA HUBLER CMo
nm up.1/1/05 Contractor/Agent is Perto e or Produced
lDNo. CC 990570 I
P)rsonaly Known t l Othe I.D. Initial
A Datej Special
Conditions: _ Utilities:
F D: Initial
R Date} (Initial k, date: