HomeMy WebLinkAbout3863 S. Orlando Dr 03-2679 Hood fire sensorCITY OF SANFORD PERMIT APPLICATION
Permit # : gypp/// ' " " Date:
Job Address: 3
Description of Work: G7 oYi U""-
Historic District: Value of Work:
Permit Type: Building Electrical LzMechanical Plumbin Fire Sprinkler/Alarm Pool.
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Tempo6ry Pole
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Replacement New (Duct Layout & Energy Cale. Required)
of Water & Sewer Lines # of Gas Lines
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, fur other than X)
Parcel #: (Attach Proof of Ownership Legal Description)
Owners Name &Address 0'/"e GL0 SGCIZ du'3 3
1 -773 Phone: 7' 32Z—
Contractor Name 40ddress
3rZ7Z3 State License N mber:
Phone & Fax: 7 7 7 ZZ r GZ- Contact Person: % Phone:
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 con-,ri ie;riced 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 withall applicable taws regulating construction
and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUI- J' 1NT YO IR' 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 tt,c 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 requireme f Flori w, FS I 4 Signature
of Owner/Agent Date gnature r ont;-rlAgen Date Print
Owner/Agent's Name Print Contra c ent's Napanim CD
o
v Q
W
0. C v
Signature
of Notary -State of Florida Date Signature of Notary Stateof Flo ate cN
C7 272 OC?
n W
Personally Known
to Me or Owner/AgentisPersonalhKnowntoMeorContractor/Agent t 1J1 Jt
w
1- Produced
IDKProducedID .tgU 711/ APPLICATION APPROVED
BY: Bldg:O (>ning: Initial & Date)
Special Conditions:
initial & Date)
Utilities: FD:
Initial & Date) (
Initial & Date?