HomeMy WebLinkAbout100 Willner Cir 05-1668CITY OF SANFORD PERMIT APPLICATION 4�.
Permit # : , 0 5, Aa_o 6 Date:
Job Address: % wU6-A'T r2 AO S /00k✓,/i(& 9277/ &Dtr A,O iJ 6,7-
Description of Work: I1L',iG:g STvcry t=OI+IC_E WOW
Historic District: Zoning: Value of Work: S.1—ge-0 ea
Permit Type: Building 1 Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool _
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: IL q of Stories: —,;2, # of Dwelling Units: Flood Zone: (FEMA form regnlred for o0w), than X)
Parcel #: _.216- 0 - 30-- c50._-2G - 000 a (Attach Proof of Ownership & Legal Description)
Owners Name &Address: Zr? WE 1911'a 'i U/ 5 Alf W N0/2!( it ✓%�tt/.NT"/Z.(li t2!(
Contractor Name & Address: P ATE V q-'V 2a 1 r4550 .. (41i L v,r,'N1 iL'l�i7r� M
/0/,/.:2 A/C:6"eL,Crrr,/i 0RL 3.2Y/% State License Number.
Phone & Fa:: _60Cj- VW -U5VI FX 7V0•• DZ%/ Contact Person: FEE %E i2 i7i41_xF y ► u 01= Phone: /0,7
Bonding Company: A11A
Address:
Mortgage Leader:
Address:
ArchitecUEngincer:
Address: 9'33
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Phone:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has comme.ncrd prior in 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 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 Olt AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
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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 agencies, or federal agencies. ,
Acceptance of permit is venfi on that'll notify the owner of Use property of the
Signature of Owner/AgentDate
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Signature of Notary -State of Florida
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Owner/Agent is nally Kn
Produced 1D
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
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C T Zoning:
of Flom Lien Law, FS I
Matare Notary -State of Florfta
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Contractor/Agent is Z_P`-Inally
Produced ID
Utilities:
(initial & Date)
(Initial & Date)
Data
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(Initial & Date) -
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