HomeMy WebLinkAbout801 Elm Ave - E05-003759 (SERVICE CHANGE) DOCUMENTS�j/"CITY OF SANFORD PERMIT APPLICATION p,
Permit #: v -2 �// Date: a � ��"
Job Address:aLv W pi
Description of Work:
Historic District: !% Zoning: Value of Work:
Permit Type: Building Electrical I/ Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS /Q/% 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:
Phone:
Contractor Name & Address
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
"j S % A%"
State License Number: / /,;7
J _
Contact Person: Awilye n®r✓' Phone: (x/47 7 / g,Z6 Li .S
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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: 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
this county, and there rrgf be dditional,4
Acceptance of
hermit, there may be additional restrictions applicable to this property that may be found in the public records of
required from other governmental entities such as water management districts, state agencies, or federal agencies.
II notify the;7-,
r of
7i
I property of the requirements of Florida Lien Law, FS 713.
&grra re of Own Agent Date u Contractor/Agent
Trint Owner/Agent's Name �� n A Prin Contractor/Agent's Name
Signature of
Date
Date Signature of Notary -State of Florida Date
r"""° DEBBIE BLANTON
MY C(Mfl'iSSION # DD laaggl
Owner/Agen is°""�rsonlly K�nbWn;Lq�� 2007
PiodllCe I -0QO-3-NOTAn}'O-Ass�t p
..�.., - oc. Co.
APPLICATION APPROVED BY: Bldg: Zoning:
h itial , Date)
Special Conditions:
Contractor/Agent is Personally Known to Me or
Produced ID
Utilities:
FD:
(Initial & Date) (Initial & Date) (Initial & Date)