HomeMy WebLinkAbout2570 Hartwell Ave 04-462 RoofCITY OF SANFORD PERMIT APPLICATION
Permit # : / ` ( Date:
Job Address: ) A
Description of Work: "A -
Historic District: Zoning: Value of Work: $ N& V `
Permit Type: Building "-.' Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service TemporaryPole 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 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: 5 Attach
Proof of Ownership & Legal Description) Phone:
N, 'b1 Contractor
Name & Address: C—,e2kvJ'.7k V—^ State
License Number: c s\ kA11` 1 Phone & Fax: —\
0. `h\ Contact Person:
U' Phone: 7 r U iJt 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 ver rt`Ation that I will the owner of the property of the requirements of Florida Lien 1G2./ Signature
o
er/Ag nt Date Signatu Contractor/, Print Owner/
Agent's Name n Print Contracto Agent's Date Signature
1 My
Comm Exp. Z124N No. CC
913488 is (htst$
K96lynlQr1A110Ae APPLICATION APPROVED
BY: Bldg: Zoning: S Inital &
Date) Special Conditions:
Initial & Date)
Produced ID
Date EMlymExp.
2/
24ICC9134_ = Utilities: FD: `
Initial & Date) (
Initial & Date)