HomeMy WebLinkAbout1206 W 10 St 12-2443 (hwh install)Application No: , _ I � of 44 '
Job Address: 1AG O & Ah J_'
Parcel ID: 4 5_4 _ 0-156O
Description of'Work..: —W
Plan Review Contact Person:
Phone:
Fax:
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Documented Construction Value: $
Historic District: Yes ❑ No
l/ l J r �J�✓ [ / Zoning:
Title-
E-mail:
Property Owner Information
Name `411)yn)"' Phone: o� - J,? yr s�-7�
Street:., �p � �� � Resident of property? Uif:,L
City, State Zip: JwArd, fl= _T_d,_27 l
j Contractor Information
Name /L.{ � Phone: ���� ��`
Street: oC// /�- ;2 Fax.: "7'40 � 4�V - if 5�
City, State Zip: (11'i �, �L -�y�j� State License No.: � L' 1y'2-;24
Architect/Engineer Information
Name: Phone:
Street: A ) I ,/�� . _ __ Fax:
City, St, Zip: E-mail:
Bonding Company:
,Address:
I J4_
Mortgage Lender:
Address:
PERMIT INFORMATION
Building Permit ❑
Square Footage: Construction Type:
No. of Dwelling Units: Flood Zone:
Electrical ❑
New Service -- No. of AMPS:
Mechanical ❑ (Duct layout required for new systems)
No. of Stories:
Plumbing 1W
New Construction - No. of Fixtures:
Fare Sprinkler/Alarm ❑ No. of heads:
Application is hereby made to obtain a permit to do the work and installations as indicated_ I certify that no
work or installation has commenced prior to the issuance of a permit and that all work will be performed to
rncct 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, beaters, 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 MAX
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE
OF COMMENCEMENT MUST HE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. 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 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 requirements of Florida
Lien Law, FS 713.
The City of Sanford requires payment of a plan .review fee. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released. A
511gnature of Owner/Agent
Print Owner/Agent's Name
pate
Signature of Notary -State of 1:Gorida Date
Owner/Agent is _ _ personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Rev 11.08
Print Contractor/Agent's Name
Date
Ia. tIF�M E E4x>t�gil0
WCabrARSs(O4M
E7fPI M AL413, 2016
BOnW MfW 1st 8W@ 1MMnCe
Contractor/Agent is " Personally Known to Me or
Produced ID Type of ID
UTILITIES: WASTE WATER -
FIRE:
BUILDING:
RECEIVED 09/12/2012 09:49
0!'/12/2012 WED 8:50 FAX 407 677 3027 cuearsCSG Customareervioe 0002/002
Page: 1 Document Name: untitled
NPOS714 Item Detail Display 09/12/12 08:37:31
SC# 093721088816
Name: GOOD, DOROTHY H: 407-324-5272 W: 407-324-5272
Sales Date : 07/18/12 Sale Amount: 809.98 Total Amount: 799.48
Time of Sale: 14:48:32 Reductions-10.50 Tax Amount . .00
Transfer to Store: 01456 Balance Due : .00
Type an, x by the Division number. Then press the desired Fkey.
Item
Sel Gft Rec Dt Div Item/Sku Description Quantity Amount
042 33185000 KEN, 9 40G L 0001 485.99
W 010 42333187 MI WH GAS 0001 289.99
010 99888187 BLDG PZRMITS 0001 24.00
010 42469187 AI WH HAUL 0001 10.00
b l�`D
F3-Exit F4-Comment5 F5-Customer F6=1temhst F7=Bkwd F8=Fwd F9=Payhst
F12=Cancel
Date: 9/12/2012 Time: 9:37:39 AM