HomeMy WebLinkAbout1000 Upsala Rd 06-1781 TrailerPermit It 0
Cl1'1' OF SANFORU PER61f1' AI'fLCCATION
Date:
Job Address:
Description of Wo
Historic District:
7 G Cel—S Total Square Footage
Zoning: Value of Work: $ le0U , <5 y
Permit Type: Building izElectrical
Electrical: New Service — It of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: 1I of fixtures
Plumbing/Neiv Residential: # of Water Closets
Occupancy Type: Residential -- Conunercial
Construction Type:
# of Stories:
Owners ante & Address:
Cottractur Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Mechanical I Plumbing Fire Sprinkler/Alarm Pool
Addition/Atteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Cale. Required)
It of Water & Sewer Lines 1/ of Gas Lines
Plunibiug Repair -- Residential or Cotiunercial _
Industrial
It of Dwelling Units: Flood Zone: (FENIA form required )
Contact Person:
State Liceuse Number:
C'ltouc:
Fa x:
Phone:
Application is hereby made to obtain a permit to do the work and installations its indicated. I certify that no work or installation has commenced prior to the
issuance of it pennit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. t understand that it separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, IIENI'ERS,'TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is and that all work will be done in compliance with all applicable haws 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: lit 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 ur igcm •ut districts, stale agencies, or lbdcral agencies.
Acceptance of permit is verification that I will notify the owner of the properly of the requirements o • 'to da L' it L• 7
Signature of Owner/Agent Date Signaht of G' ntract r/Age t Date
Print Owner/Agent's Name Pri t-C(kntractor/A eut's Name
Signature of Notary -State of Florida Date Signature Wf otarylate of Flom Date
` 1/ Df F3HIE.* iSU�i ITCi 1
t .�,,r)11 /a
Owner/Agent is _ Personally Known to Me or Contractor/Agcitt is r't 11"Pci"sonnlly Known to Me or
Produced ll) �.Prudu'ced ID'�
APPROVALS: Z NIN 1/7/06- U"rtL: FD: ENEi: w�� BLDG:
Special Conditions:
Rev 03/2006
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