HomeMy WebLinkAbout1408 Williams Ave 04-02 Water heater replacementPermit # :
i ,
Job Address: ILALA ® N
Description of Work:
CITY OF SANFORD PERMIT APPLICATION
Date:
l I Ci lm.s A-4 &hA0 /— G
GcPmQv- wa4er hi:x+er
Historic District: Zoning: Value of Work: $ "00
Permit Type: Building Electrical Mechanical Plumbing L 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 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 X Commercial Industrial Total Square Footage:
Construction Type:_ # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Attach Proof of Own
Phone:
Legal Description)
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Contractor Name & Address: C-6S Y I L't VYl h 1, 0 V I CeS, Z" C_ , . 3136 N 0C1 c-,,( -
tv 1+0 r 01 k , 327 -3 State License Number: CF — Co Sr(q `i 6
Phone & Fax . 960`I1 3138WW IST5 Contact Person: 0(,l4'kC11 n hihWC.LkCA Pho.43SO 7400 l1v 1nG 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 pr p may be found in the public records of this county,
and there may be additional permits required from other governmental entities such as wat r nag m in is ictMtate agencies, or federal agencies. Acceptance of
permit is verification that I will notify the owner of the property of the requirements ida LiV, Signature
of
Owner/Agent Date Signature of Contractor/Agent Date Print Owner/
Agent's Name Print Contractor/Age is Name Signature of
Notary -State of Florida Date Signature of No -State of Florida Da Owner/Agent
is _ Personally Known to Me or Contractor/Agent is Personally Known to Me or Produced ID
Produced ID APPLICATION APPROVED
BY: Bldg: initial & Date)
Special Conditions:
Zoning. Initial &
Date)
Utilities: FD-
Initial & Date) (
initial & Date) NANCY SKATES.
WEARY 0r P°°
Commission # D00134673 y - Expires
7n1=06 y!' gFn.
e' i Illiila'
BOfW6d tilt0u
h e.80Q
e32.47m) FWWa Notary Asen.. line.
111997
rem Fammuggom
I her Wmame/and ppoi
Of Lz f to be my lawful attorney
in fact to act for me and applyl to or J for
a /C permit for work to be performed
at a location descnl3ed as: Section Township Range
Lot Block Subdivision
Address of Job)
U IV l
Owner of Property and Address)
and to sign m name and do all ffmgsn=ssary to this appaintsnent
Type or a= and License#)
S*maaae ottwffied Contracbor)
Ac%mowledged:
Swom to and subscribed before me this
Day of 001 nbckA.D. 900 Notary
Public, State of Man& ••••••••• ..........•.••••• NCY SKATES -WEARY O`
PaYF ?f:;• Commission # DD013073 seal)
Expires 7/21/2C06 5 '
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Q( Florida
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