HomeMy WebLinkAbout1006 Scott Ave (2)Permit #
Job Address:
Description o
Historic District.
CITY OF SANFORD PERMIT APPLICATION
Date: Y IS' -- Q 5
Gonmg: value of work: �i -< o{C)O
Permit Type: Building Electrical Mechanical Plurnbinge 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 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: 4 L e-lAe vt
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Phone: 30� /--3s E,
Contractor Name & Address: RVLA 10-cteo,
�x� a •sMri fir? (� State License Nu er:
Phone& Fax:(-` jSC ` Contact Person:�f/ Phone:.5�1�
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: 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 pennit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. 1 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 Florida Lien Law FS 713.
4,4
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name Print Contractor/Agent's Name
OQQ Q- f -�
Signature of Notary -State of Florida Date Signat ota State of Florida Date
"DEBBIE BLANTON
MY CoWiflSSION # DD 188491
Owner/Agent is _ Personally Known to Me or Contmc or/(W EXF D.n4Ul biytltF€+Stedde or
Produced ID P d�ta�dp.,,- r, 0,
APPLICATION
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Zoning:
Utilities:
FD:
(Initial & Date) (Initial & Date) (Initial & Date)