HomeMy WebLinkAbout2020 Washington Ave - P05-003588 (RELOCATE METER) DOCUMENTSPermit # : O- LI ' 11
Job Address: eLN � C UJI Ac, ' I W 6 7-0 N
Description of Wor �LOCr4ils N %
Historic District: Zoning:
Permit Type: Build
Electrical: New Sen
Mechanical: Resides
Plumbing/ New Cot
Plumbing/New Resi
Occupancy Type: R
Construction Type:
CITY OF SANFORD PERMIT APPLICATI(
Date:
AUL S.4s,31FvA0 SGL.
Value of Work: S 11,50 d ' czo
Electrical t/ Mechanical Plumbing Fir Sprinkler/Alarm Pool
- # of AMPS IJA Addition/Alteration Change of Service Temporary Pole
Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
:rcial: # of Fixtures # of Water & Sewer Lines # of s Lines
tial: # of Water Closets Plumbing Repair - Residential or Commercial
ential Commercial Industrial Total Square Footage:
# of Stories:# of Dwelling Units: Flood Zone: (FEMA form required for other than x)
Parcel
Owners Name & Addr ss: 75E(`t C) F, Y Au Lar 0 C l
Contractor Name & Address: �IF uC'( l Oidll^•
(Attach Proof i f Ownership & Legal Description)
Ko'i -3a I-'tooL4
1 S3� I.Vo 1`tCA 5�tJ • ',�(`I TDAl,A�- �Lp a7 (� S State License Nuf tuher: "�a!��'L� �6
Phone & Fax: 3%t0'1_n_I - ZY`f9' ' `- �� 1 Contact Person: 'PAL,6' 15 LUPU WU_Phone: JSi6 D 0el' 6)_7/2
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: I Phone:
Address: I Fax:
Application is hereby m Ide to obtain a permit to do the work and installations as indicated. I certify that no I ork or installation has commenced 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 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 I MENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNE EFOREE' LECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE n addition t he requirements of this permit, there maybe additional restrictions applica a to thi p operty that may be f in th lic records of
this con , and there be additional permits requir m other governmental entities such water a s cts to genc" , or fe agencies.
Acceptan of pe is "fication tha n wner of roperty of the require nus Flo " L" La , FS
•
Sig re of wner/Agent ate y Sjfdatur_e of Contra or/ gent ate
PriOwner/ Agent's Name Prin tractor/Ag is N me
_4 7-IY-45
S of t lotaState of Florida Date S igliature of No -State of Florida Date
fiMWIICK DONNA D. SOUTHWICK
DONNA D. 50U
NOTARY PUBLIC
STATE
#TDD344 j NOTARY PUBLIC - STATE OF FUdRiUF
�r����������'CCI COMMISSIONO# DID344712
Owner/Agent is Personallycm2008
IIf eSor912312008 Contractor/Agent i "Personally KnouF� WWW§
_ Produced ID {{{"'ll'KC NOTARYi _ Produced IDBONDEDTHRU I_s8 -NOTARYI
APPLICATION APPROVED BY: Bldg: F -►1 Zoning: Utilitiel: FD:
(Initial ate) (Initial &Date) (Initial &Date) (Initial &Date)
Special Conditions: