HomeMy WebLinkAbout300 W 12 St 04-46 HVACPermit #
Job Address: .3[) U
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Zoning: Value of Work:
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — #Xon-Residential
PS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Wate losets 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 otlin ff-iia,n X)
Parcel #:
Owners Name & Address:
3ay LJ to
Contractor Na e & Addr
e
Phone & Fax:
Bonding Company:
Address:
Attach Proof of Ownership & Legal Description)
Phone: - Jit.) - 7j167
State License Number:
Contact Person: Phone:
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 to s regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU13. 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 verification that I will notify the owner of the property of the require nts of Florida Lie La FS 713. Z 292A/C?/
Signature of Owner/Agent Date Signature of Contractor/Agent Date
son
Print Owner/Agent's Name Print
MContractor/
Agent's Name (
p l
Signature of Notary -State of Florida Date Signature of Notary -State of Florida ' Date
Owner/Agent is _
Produced ID
Personally Known to Me or
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions: 0
Zoning:
P
iMichelle
C. Burk Contractor/
Agent is +' Personally Known t4 r My Commission OD223324 Produced
ID fi Expires June 16, 2007 Utilities:
FD: Initial &
Date) (Initial & Date) (Initial & Date)