HomeMy WebLinkAbout1751 WP Ball Blvd (fr sp relocate) (a) (2)f. ,� v •i rye?' ^9tltCYr;�yC�` t�tS.?f 1 A. �`;'r r 11 'i (i I; 1 "+�7i it4 4. ri, t ,.�+ t° ci'`'' M•`a �N i \ x Jias g' ??c , 1 ).� r q�.M1 ov ,
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CITY OF SA,NFOR:J'PERIAN' APPLICATiQN
Permit # : t 1 lay t Dates: -Z— u,�
Job Address: �i���.�.1'- �� •-c�L �1-.--�. �6�1�i.__��L
Description of Work: A fAf- f.JO J T — 4--1 1Z,F
Historic District: `- Zoning: Value of Work: $ �a�• cQ --�
Permit Type: Building Electrical _. Mechanical Plumbing Fire Sprinkler/Alarm ✓ Pool
Electrical: New Service - # of AMPS Addition/Alteration
Mechanical: Residential __ Nfon-Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Conunercial
Change of Service; Temportiry Pole _
_ Replacement New—_ (Duct L.4yout & lnergy Calk Require d)
It of Water & Sewer Lines # of Gas Lines
Plumbing Repair— Residential or Commercial
Industrial 'Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: _ (FEMA form required for other than X)
Parcel #: C> O� - AZO (Attach Proof of Ownersh;p & Legal Description)
ONvncrs Name & Address: SF m 14 ICaI_ ^ t yj (-X9t F -T IR
Phone:
ContractorNa.me &''Address: L _I I•ell�t.l [`kL{y�' �rC 1c�o t - l -----
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State License:Number:ern ' i OL7C�C�( ZC^SJZ
'tea _/_ �L�___..—.—......._._.�_ ..._......_.
Phone C Fux:�`Z-�Cs�c� ®�{'(�aIT—?✓ f��C' n �ci o hr rN, I
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BondinoComnanv. -� v �,,. ,.
Address:
kende,.---••.._._r._..—
Address: rr 1 E, ?nn5..
Architect%En ;ineer:
Address,
Phone:
Fax:
Application isherebya made to obtain a pcnru pe (Jt ouk d tr ndicated. I certify that no work or insta[Iation has coinntcnce'd prior x�a ilrc
issuance of a permit and that all wort: vrill be rf rn d'$b rr>eef-- fandardS=0f'sII laws regulating construction in this jurisdiction. [understand that a separate
perm, must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDI FIONER.S, etc.
OMNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applica[alo, lzry✓a; re..r,r.ifl';ain�
construction and zoning. WARIv1ING "I'0 OWNER: YOUR FAILURE TC) RECOKD A NOTICE OF COMMEP�CEMENT MAY RESULT 1.I �`f i i,1'r: F^E , 'ESRC;
TWICE FOP, II 4PROVEMENTS TO YOUR PKOPER'fY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTQIINEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NKK - f -CE: to addition to the requirements of this petzrrr, 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 pert tits required from other governmental entities such as v.,ater management districts, state agencies, or r.ede:ral ag;a�cies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida i ien Law, FS 7 t3.
Siarnature of Owner/Agent Date Signature of Contactor/Agent ---
Date
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�li �G��WG!1b1/(rriU" I%"015
Print O)vner/Agent's Name Print Contractor;cat's lamr
ul//liw�,,a�� Ill c , "
Sit, ture of Nry
ota-State of Florida — "'-"-- �- TE• o7Pin5i ie D139322
---bate ,I;nature of o:ary-State of Florida ata
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r„ExpitesAugusI05,2006
Omner/Agent is _ Personal))Kn(.tmn to Afa or C: ontractor/Agrc: u _ I'ersonall': known to h1e or
Produced
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AP1'l_IC;:A'f10N AlTlv0VEL) BY: 131d��
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