HomeMy WebLinkAbout1104 S Elm Ave - M,05-002258 (AC CHANGEOUT) DOCUMENTSCITY OF SANFORD PERMIT APPLICATION
Permit # :Date:
Job Address:
Description of Work: A- lg & C lnl Li r- % oyw,/y
Historic District: Zoning: ,4e. I Value of Work: $ 0D0o &
Permit Type: Building Electrical Mechanical V/ 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: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: '-
SSI G14AF-1E16 Phone: 9L6'_'7-
Contractor
y�-
Contractor
�
Name & Address:
State License Number:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Engineer
Address:
Contact Person:
Phone:
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 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 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 governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance o permit is ve i tcati n.that notify the ow er of the property of the requirements of Florida Lien Law, FS 713.
IFS r
ignature of Owe /Agent Date Signature of Contractor/Agent Date
rint nt_'s N e Print Contractor/Agent's Name
Signature of Nota -Stacy to of Florida Date Signature of Notary -State of Florida Date
"" °� DEBi3! T N
MY C '. ;'d!' SlON # 188491
Owner/ ge %;thy' P onall -. -ag,h� 2007 Contractor/Agent is _ Personally Known to Me or
Pro u d bD _ _ Produced ID
uJy..+.,..e=lt-Ant-C. Co.
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Zoning:VF' L(70& Utilities:
(Initial '& Date)
FD:
(Initial & Date) (Initial & Date)
CITY OF SANFORD HISTORIC PRESERVATION BOARD
APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
P.O. Box 1788, Sanford, FL 32772-1788
Phone: 407 330-5672 Fax: 407 330-5679
TO: THE HISTORIC PRESERVATION BOARD OF THE CITY OF SANFORD, FLORIDA
❑ Downtown Commercial Historic District ❑ Residential Historic District
❑ This application is filed in response to a notice from the Code Enforcement Department
ADDRESS OF PROPERTY:
C
Signature:
Mailing Address:
Phone: Fax:
A licant/A t I
Signature: ,
Mailing Address:
Phone:
Fax:
Print Name:
Print Name:
I certify that all inform tion contain din application i� true and accurate to the best of my knowledge.
Applicant/Owner: Date: %— Q / — O
Please use the attached criteria ecklist a guide to completing the application. Incomplete applications cannot be
reviewed and will be returned to you for more information. You are encouraged to contact the preservation planner at
407-330-5672 to make sure your application is complete.
Description of Proposed Work/Application Category: (Check all that apply)
❑ Site Improvements/driveway/walkway ❑ Storage shed
❑ Moving structures
❑ Replacement windows or doors ❑ Underskirting
❑ Awnings
❑ New construction/additions ❑ Signs
❑ Demolition
❑ Roofs/gutters/downspouts XAC/Mechanical
❑ Fences/Gates/Pergolas
❑ Replacement siding/flooring/porch ❑ Paint
❑ Other
Completely describe the entire scope of work: all changes in material, color or location to the exterior of the building,
where on the property the work will occur and how the work will be accomplished. For large projects, an itemized list is
recomme ded. Attaci� additional pages if ne essary. l
N i N T E N
-_S' STi etJ N
IA% G/
D� k o✓ST/a / �1/ruJ
% s
-
A Certificate of Appropriateness is valid for six.uionths unless otherw sp note cP
OFFICIAL USE ONLY
Historic Preservation Board Meetin Date: Staff Review Date:
Application is Approved Approved with Conditions Denied
Conditions:
Signed:
Date:
***This Certificate must be prominently displayed on the building when work is in progress***
FASHA ENG\Historic Preservation Board\C of A Application.doc