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HomeMy WebLinkAbout114 S Palmetto AveCITY OF SAN FORD PERMIT APPLICATION Permit #: y ' /yj Date: 6 "3 -Q .5 Job Address: l S . �c e.` r+• �` V Description of Work: K✓m Historic District: Zoning: Value of Work: $ 3. ��(i 00 _ T Permit Type: Building Electrical Mechanical � Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service - # of AMPS Addition/AIteration Change of Service Temporary Pole Mechanical: Residential Non -Residential k'� 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: I { , Construction Type: 1 # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: (Attach Proof of Ownership & Legal Description) Owners Name & Address: Y -\-,i, �W_sfG �) � .5. Vo,-) m,46 ✓• ` Phone: Contractor Name & Address: A �- �� �!5 'e r!5 11 V - D , LGt,ke_ 77,&r / r G . State License Number: c'-7AC� 4 Phone &Fax: Q 7 �-?j -� Q/ �'JD Contact Person: i�� \Y� S Phone: Boadine ComDanv: Address: MortEaee Lender: Address: ArchitectfEngineer: 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 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 requirements of Florida Lien Law, FS 713_ Signature of Owner/Agent Print Owner/Agent's Name Signature of Notary -State of Florida Owner/Agent is _ Personally Known to Me or Produced ID Date Signature of Contractor/Agent Date Pr=tlslqbne (p v X Signature of Notary -State of Florida Date Contractor/Agent is _ Produced ID _ APPLICATION APPROVED BY: "a : h wZoning: Utilities: 1V V ( 6tial & Date) (Initial & Date) Special Conditions: Personally Known to Me or FD: (Initial & Date) (Initial & Date) CITY OF.SANFORD. HISTORIC PRESERVATION BOARD 'APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS P.O Boz 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: Property Owner . Signature: P6A-e.,_ ,N p r/5p_ Print Name: Mailing Address: Phone: _ Fax: Applicant/Agent . Signature: Print Name: �P a4 g <, Mailing Address: �. ©�� 9,6 7 Phone: 4& 7 - 323 - .Z44_ Fax: I certify that all informat' n co Fined in this application is true and accurate to the best of my knowledge. Applicant/Owner: Date: Please use the attached criteria checklist as a gu de 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 o Signs t .. O Demolition ❑ Roofs/gutters/downspouts AC/Mechanical o Fences/Gates/Pergolas E3 Replacement siding/flooring/porch ❑ Pamt ❑ 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 recommended. Attach additional pages if necessary. A 0✓ 4 % nJ tL2 �aEr�� A Certificate of Appropriateness is valid for six, months unless otherwise noted OFFICIAL USE ONLY Historic Preservation Board Mee g Date Staff Review Date: Application is Approved -Approved with Conditions Conditions: Signed: Date: Denied ***This Certificate must be prominently displayed on the building when work is in progress*** F:\SHA_ENG\Historic Preservation Board\C of A Application.doc �-� 1 m,2,4a F -,x p 0.�; ej r-o)J A,,� N -?