HomeMy WebLinkAbout801 W 1 St 05-3232 Install SignRECEIVED �
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CITY OF SANFOI U PERMFF APPLICATION �+ / I I I Ni n R )nn;
Permit #
Job Addn
Descriptic
historic District: (�Zoning: Value of Work:
Permit Type: Buildingm_-n_ Electrical Mechanical Plumbing Fire Sprinkler/AlarPool
Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures I/ of Water & Sewer Lines It of Gas Lines
Plumbing[New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage: _
T
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
J
Contractor Name & Address:
(Attach Proof of Ownership & Legal Description)
Phone:
A tr_, ' [7 State License Number:• r�
Phone & Faa: T dr� rUf3 �t ������ 5 Contact Person: _ I� ---Phone: __ - a4��_��%
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 conuuenced 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 AFFIDAV rF: I certify that all of the foregoing infonnation 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 govern men(al 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 requirerpCnts/of Florida Lien I yud I'�, i13.
Signature of Owner/Agent
Date S
Print Owner/Agcnt's Name PriuCoutrac or/Age is re
Signature of Notary -State of Florida Date Signatu of Notary- ' • of Date
MY COMMIalm fk OD 164200
*'
vs " kXPlFl< Novarober 12' 200pi
Owner/Agent is _ Personally Knowto Me or Cori i i-'glgenFiB`IedThru 1�' gin° lt� I�ioe n n to M_ e or _
Produced ID _'roduced !D >
APPLICATION APPROVED BY: Bld_�a(oning:�`' �� Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
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