HomeMy WebLinkAbout808 W 25 St - E05-003515 (FIXTURE CHANGE) DOCUMENTSCITY OF SANFORD PERMIT APPLICATION
Permit #: 0� 3 � �, 9� Date:
Job Address: �nq G✓ , S �rf ,
Description of Work: e
Historic District: Zoning: Value of Work: $
Permit Type: Building Electrical Mechanical PlumbingFire Sprinkler/Alanrt 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: /25 So Y-C!� S 10.7
Phone:
Contractor Name &Address:,
w, C �; sP �✓ / X707 State License Number:
Phone & Fax l Contact Person: L, d Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
Application is hereby made to obtain a pennit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a pennit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. 1 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: 1 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 pennit, 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 fiom other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of pennit is verification that 1 will notify the owner of the property oft lie requirements of Fl ida Li r FS 13.
Signature of Owner/Agent Date nature of Contractor/Agent Date
6
Print Owner/Agent's Name Print Co racto s Name
' D —
Signature of Notary -State of Florida Date SiggaturwQf No L* C&A� r- Date
k MY COMMISSION # DD 164280
XPIRES:Navedef 12, 2006
0onded Thru Builvi Notary Services
Owner/Agent is Personally Known to Me or ContraetdrAgent is Personally K11 11 to Mleror /^, l
Produced ID Produced ID %�(�-^L�1�j "� �I 'vS
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Zoning:
Utilities:
FD:
(Initial & Date) (Initial & Date) (Initial & Date)
DIVISION OF BUILDING INSPECTION
TOWN OF LAKE 'PARK, FLORIDA
Final Date Approved. Apr.! 1..1 ...............1957-1. Date of PermMo%i, ..19 • • • • • • • • • • • • • • • • • • • •195M
Bldg. No...................Bldg. Insp. Wm. - A.: Wt ison
Mec. Insp. ... Vim. A . —W i .ls on ..................... Lot - -unp l a•t ted ....... Block................ .
Plumb. Insp. .'Wm.. •Av •W4-1s0n • • • • ...............
Roofing Insp. Wm'." A.... W i• 1 son..................... Permit No. .07261 ... .
Sidewalk. & Driveway Insp. Wf1i...A..:W.i.1SOn......
Warehouse
118 18 to Certify, That the ........................................
1145 01d Dixie ,and owned by Heritage North Bldg. Corp.
Located at No. .. Hwy.. a
Built by ... Qw�e r • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • . was inspected and found to conform to all Code
requirements of the Town of Lake Parka. Florida ' and is approved , for all utility service and occupancy, for
use stated in Permit only: r /�
30 day temporary permit, subject to ••• A!° ` "` "" """"'
Building Inspector
spray room equipment installation