HomeMy WebLinkAbout130 N Scott AvePermit # :01S �I>`2
Job Address:
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date.
Value of Work: $ 7.000
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Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # ofAMPS
Mechanical: Residential —1,,- Non -Residential _
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
Parcel #:
Owners Name & Address:
Contractor Name & Address:
Addition/Alteration
Change of Service Temporary Pole
_ Replacement L ---New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines
# of Gas Lines
Plumbing Repair — Residential or Commercial
Industrial
Total Square Footage:
# of Dwelling Units:
Flood Zone: (FEMA form required for other than X)
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(Attach Proof of Ownership & Legal Description)
Phone:
'220V 04e Ave e�y/�lJ� -.7eZ %i / Stato
State License Number: Ln Y�9Go2
YK497--yG
Phone & Fax: - /z "6 / (� y Contact Person: 5* U Phone:
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
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 of permit is verification that I will notify the owner of the property of the requir mems o o a Lien 3.
Signature of Owner/Agent Date ignature of Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to
Produced ID
APPLICATION APPROVED BY: Bldg: ping:
(Initial &
Special Conditions:
Pnn Contr 7tors's Name
Signatii @.Qy ptaryLSMO, Datel
* * MY COMMISSION 4 DD 164280
EXPIRES: November 12, 2006
8ode r Budget Notary Servicee
ContractoiY Sgent is personally Known to Me or
Produced ID
Utilities:
FD:
(Initial & Date) (Initial & Date) (Initial & Date)