HomeMy WebLinkAbout300 W 12 St 04-679 fuel line to furnaceCITY OF SANFORD PERMIT APPLICATION
Permit # .. Date:
Job Address: z
rr
Description of Work:
a
C) 'n t t 410p00
Historic District: VJIa iS — _ :omng: _ _ Value of Work: $ }'cy
wj.
Permit Type: Building Electrical Mechanical Pl mbing / Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Polo
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines I
Plumbing/New Residential: # of Wat r 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 #: f %; 5 G 13v6 - 4415-0 (Attach Proof of Ownership & Le al Descrfiption)
Owners Name & Address: Run (, 1 '30 I .244 S-& S il ll l (/1 Eli_ .3 Z 77
Phone: Lf 0') - 3"
Address: WL2i,A YU
2 13' U State License Number: (_l- G CJ 5 V J' ' D
Phone & Fax: 3 6 7q 79 6/9/ 'GU `/ on act Person: {ll' I/CYI I l Phone: 30CJ' %f % 9
Bonding Company:
Address: V nE
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
Application is hereby made to obtain a permit to do the work and in tallations 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 s s of l u struction in this jurisdiction. I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, S EL R ACES, 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 ages, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property oft
Signature of Owner/Agent
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or Contractor/Agent is Personally? n to Mepr
Produced ID _,,L\-i4oduced ID
APPLICATION APPROVED BY: BldG\ '^ 1 j Zoning: Utilities: FD:
Initial & Date) (Initial & ate) (Initial & Date) (Initial & Date)
Special Conditions:
211
di5• • • Now ,
rt
a cocon
o oC7
N w
O
n O N +'
v, w S
111997
Date: ` I _
I hereby name and appoint
vi viu to be my lawful attomey
in fact to act for me and apply to .[ for
a permit for work to be performed
at a location described as: Section Township Range
Lot Block
p
Subdivision
Addrm oflob)
and to sign my name and do all things necessary to this appoint a aent.
sue
Aclmowledge&
Sworn to and subson-bed before me this
Day of A-D.
Notary Public, State of Florida
Seal)
We) Ali n ,M, M' • .
1
NCY SKATES -WEARY
Commission # DD0134673
Expires 7/21/2006
y lli' OQP
o`° Bonded through
800-432-4254) Florida Notary Assn., Inc.
a.............._
permit# :
license#: CFC057164
license name:florida public utilities
address :300 W. 12TH ST. Sanford, FI.32771
gas type : natural
pipe type :csst/galv.
longest run:80 ft.
sizing tabie:trac pipe N4
btu load 110,000
15 ft.-112"-(wall mount)
double meter manifold
3
30 ft:-112"-(attic)
10 ft-112"(Closet)
110,000 btu furnace
25 ft.-1 /2"-(underground or wall mount)
d6 I :SO 60 60 oaa