HomeMy WebLinkAbout218 S Laurel AveCITY OF SANFORD PERMIT APPLICATION I "�
Permit #: O� U�J�J1 Date: t �'
Job Address: A j 11(�j� AQ
Description of Work: R (e �t
LUstoric District: Zoning: Value of Work: $Ass y
Permit Type: Building Electrical
Mechanical Plumbing Fire Sprinkler/Alarm 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
(Initial & Date)
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 #: J 1 - 3 O - 5A(9 ' O 400 — 005o
(Attach Proof of Ownership & Legal Description)
Owners Name & Address: `' t� on
S' , ( vi � Phone:
Contractor Nam'Je & Address:
Gr V Q e
• O T,� ` _ State License, Nu
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Perso
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 +York will be performed to meet standards of all laws regular ng construction in this jurisdiction- I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGN'S, WELLS, POOLS, FURNACES, BOILERS: HEATERS, TANKS, and
AIR CONDITIONERS. etc.
OWNER'S AFFIDAVIT: I certi'` that all of the foregoing information is accurate and that all work will be clone 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 PAYLNG
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 requements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of
this county. and the -e 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 nts of Florida Li Law, FS 713.
���1 i05
Signature of Owner/Agent Date 5 isaturc o radar/Agent Date
�l
Print Ov.ner/Agent's N enc
SignanUc of Notar%-Statc of Florida Date
Pru Contractor/., ac Name
at�GS
Siunatwc<Vi(upcw-h a Date
* W COM�9ISSION #« OD 1642A•
EXPIRES, November 12, 20(1,
o 4adThruBudq.^.1NOWVSe"a "
Owner Agent is _Personally Kno+Vn to Me or
Precuccd ID —
or, .
Contractor/:Age t i Pers lly r w o Ic or
_
Produced ID
APPLICATION APPROVE7BY:B311d,4:
Zoning: 6itics:
FD:
ial Date)
(Initial & ace)
(Initial & Date)
(Initial & Date)
Special Conditions: -
POWER OF ATTORNEY
Date: 7/20/05
I,mqka 66P,f , do hereby authorize SU.? "4ow-�
to pull the gas plumbing permit for Vii$ AU -SSC 01
address
Signature
Martha Jackson Hartman
*_ Commission #DD244694
Expires: Oct 10, 2007
�9 OF iN.0 Bonded Thru
Atlantic Bonding Co,, Inc.
na Jackso"artma , Notary
Personally know me or drivers license #
e -e# nda, County of �J O W-&4 e—, —on _qday of
',T( LA .2005