HomeMy WebLinkAbout114 Palmetto Ave (2)CITY OF SANFORD PERMIT APPLICATION
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Permit #: Q� ' (J Date: 9 0 J
Job Address:
Description of Work: /ivi2JtCE �pt�ri
Historic District: Zoning: Value of Work: $ 1 q OD.
Permit Type: Building Electrical )— Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS 2CD Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets_
Occupancy Type: Residential Commercial
Construction Type: # of Stories
Replacement 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)
Parcel #: ' (Attach Proof of Ownership & Legal Description)
Owners Name & Address: i iE1& � Ous>fi DS 0 A)CA PS
Phone:
Contractor Name & Address: Fe IJIX-li ryy"�ic- Lie, ?-6 13 D& 14065 3 Zi
State License Number: j5iC 6ob 1 S by -
Phone &Fax: Contact Person: Ep Ko..a "<-) Phone: �% d 7 33 L
Bonding Company:
Address:
Mortgage Lender:
Address-
Architect/Engineer: Phone:
Address: Fax:
Application is hereby made to obtain a pennit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance ol'a permit and that all work will be perfornied 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 infonnation 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 pennits 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 requiremen f Florida Lien Law, FS 713.
�udk• 8' 19 61'
Signature of Owner/Agent Date Signature of Contractor/Agent ate
awd !! D �t, QZile/
Print Owner/Agent's Name Print Contractor/Agent's Name
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Signature of Notary -State of Florida Date Signature of Notary -State of Flonda Date
Owner/Agent is _ Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID Produced ID �!,. e. 't- . 3
APPLICATION APPROVED BY
Special Conditions:
J�rut�a'j Zoning:0 �- `� Utilities:
Date) (Initial & Date)
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FD:
(Initial & Date) (Initial & Date)