HomeMy WebLinkAbout1412 E Valencia CtPermit # : 0 l " �q b [ y
Job Address: tee_ (a 9 / �)_
Description of Work:
Historic District:
Zoning:
CITY OF SANFORD PERMIT APPLICATION
Permit Type: Building Electrical
Electrical: New Service - # of AMPS
Mechanical:estdenti Non -Residential _
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: elide Commercial
Date: 0 (v 0 G O S
Value of Work: $-3, ? «�
echan' Plumbing Fire Sprinkler/Alarm Pool
Addition/Alteration Change of Service Temporary Pole
Replacement ew (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair - Residential or Commercial
Industrial Total Square Footage:
Construction Type: / # of Stories: i # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: ff n (Attach Proof of Ownership & Legal Description)
Owners Name & Address: l ��1 l �9✓1 5`
Phone:
ttContractor Name &^Add�rpess�: _ / 6
(�-N(? State License Number:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: -
Address:
Architect/Engineer.
Address:
Contact Person: Phone:
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: [n 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 of Florida Lien Law, FS 713.
Z"P&04444:�
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida
Owner/Agent is _ Personally Known to Me or
_ Produced ID
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Print Contractor/Agent's Name
Date Signature of Notary -State of Florida Date
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BLANTON
ct
o Aor;geflt
is t, iF-,' Fe�sotl4plClg® to Me or
(t tRPocluced ID, 64-F:FE?brua[y 25, 2007
TPj!Y ..��. rNriza; r -int Assoc. Co.
Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date)