HomeMy WebLinkAbout655 Fulton St 05-505 SignCITY OF SANFORD PERMIT APPLICATION
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Permit #: lJ \ - D/ate:
Job Address: L O/y vim/ _ / G7. 1-2
Description of Work: e4nt2L
Historic District: Zoning: C - Z Value of Work: $
Permit Type: Building Electrical
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential
Mechanical Plumbing Fire Sprinkler/Alarm Pool
Addition/Alteration Change of Service Temporary Pole _
Replacement New (Duct Layout & Energy Calc. Required)
of Water & Sewer Lines # of Gas Lines
Commercial Industrial
Plumbing Repair - Residential or Commercial
Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form requi.r od for other than X)
Parcel #:
Owners Name & Address: 0
Attach Proof of Ownership & Legal Description)
Phone:=
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Contractor Name & Address: 6 Gw t,, 2 __-.--
State License Number:
Phone & I
Bonding
Address:
Mortgage Lender:------.---
Address:NOV 0 2004
Architect/Engineer:
Address:
Phone:
hiApplicationisherebymadetoobtainapermittodotheworkandins1t'ons as11ty, if that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet stan arf swctiott: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 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 v/ynf" on that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713
Fat e nt Date Signature of Contractor/Agent Date
Per/Agent's Name Print Contractor/Agent's Name xv-
idkA, / / /0- Signature
of Notary -State of Florida Signature of Notary -State of Florida Date DEBBIE
BLANTON MY
COMMISSION # DD 188491 Owner/
Agent is P Kn5)IFiiRi;UEeNuary 25, 2007 Contractor/Agent is _ Personally Known to Me or Produced
ID r— ri Notary Discount Assoc. co. _ Produced ID APPLICATION
APPROVED BY: Bldg () Zoning: N (' 2' Utilities: Initial &
Date) (Initial & Date) Special
Conditions: o -\-
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Initial &
Date) (Initial & Date) Ids
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