HomeMy WebLinkAbout1008 Palmetto Ave - E05-002612 (REWIRE) DOCUMENTSo4
Permit #: Q
Job Address:
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date: 5- i Z-0 5
.me -t't'o W v e-
ve
ve (Zt 06 K }6ae, 'eynOvc e t o 11"W-00 e 7y fe-
Zoning: Value of Work: $ A 2.2c 8 e!O13
Permit Type: Building Electrical _Mechanical Plumbing
Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS ire Addition/Alteration i� Change of Service emporary Pole —7
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: C -191J Cav4� ✓
100% �I bneMO Alli �'��d✓C AZ' 32171 Phnne-
Contractor Name & Address: A-454-77.&- 60 . VC J W k;0elLt//s! ? /�
ZS22 5 �i9rlT i�rw� S License Number:: �i 1i�,3G'10/'9943
Phone & Fax: 4e9-� 3ZZ.^ 1542- Contact Person: i D 44150 fQ Phone: 4iD% 920 3505
ir
Bonding Company: _0( -4 01
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 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 30 00
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 of permit is verification that I will notify the owner of the property of the require men lorida Lien La 13.
/�•a S
Signature of Owner/Agent Date S' a e of ctor/ Date
Print Owner/Agent's Name
Ph it C ntra t r/ nt's Name
je ala -
Signature of Notary -State of Florida Date tgna re of Notary -State of Florida Date
�z, FJe
FLORENCE nA. DE GRAVE
Owner/Agent is _ Personally Known to Me or ConAd
et5tMts � %SI�dn '11Q7CtTo�3ti to Me or
_ Produced ID IDn "'L": IV�vefli�er 12, 2006
o Sr,n a ru budget Notary erwces
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
(Initt Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
>o �ROZA�yelMi IF
FYI