HomeMy WebLinkAbout2432 Chase AveCITY OF SANFORD PERMIT APPLICATION
Permit #:- Date: / a
Job Address: a 5 P A t,
Description of Work: '^ 040 f
Historic District: Zoning: Value of Work:
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 Plumbing Repair — Residential or Commercial
Occupancy Type: Residential 1�/ Commercial Industrial Total Square Footage:
Construction Type: # of Stories: / # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: -310 — I f — J V — (JO — / (Attach Proof of Ownership & Legal
Owners Name & Address:r___4 a, �C.rte4 9. Sr! SG �r ei S ./Q�pLro Kc tr; S_&_I
Phone:
Contractor Name & Address:
Ocoee, /--G 3 x`76 / v Statte� License Number: CCC Q 3.3 7�2
Phone & Fag: 4 7—65/�-r4,�7 Contact Person: T46A' 5C" S(?V`_4 Phone:
Bonding Company: 411A
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address:
Fag:
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: 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 requiremen of orida Lien Law S713- 01
Signature of Owner/Agent Date f Contractor/Agent G�att.s:
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
_
Produced ID ��'QQ
APPLICATION APPROVED BY. Bl tT. ming:
(Initial & Date)
Special Conditions:
(hritial & Date)
VrA,<
is me
h���
FNotaif-State, 1 ri a Date
DEBBIE BLANTON
pilmy CDPv""+s li 'iON # DD 188491
h ent ist�>:1' ,Personf3lihyyl�q&bpto M or
Utilities: FD:
(Initial & Date) (Initial & Date)
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company:�k� o�iKa
License #: CGS' a 33 712
Project Information
Owner. �(ti�H (es �. �t SL,saH Permit #:
name
_?2 G has cc Subdivision:
address
Lot #:
phone
=. eo-s , affiant, hereby affirm that I am the duly licensed
contractor of r cord for the above referenced permit, that all the foregoing information is true
and accurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accordance with the applicable codes and standards.
Contract
STATE OF FLORID
COUNTY OF
This instrument was acknowledged foreemmeJ�s _ day of �l� , 200 by the
above referenced individual, — ,who acknowledged that he/she is a
duly licensed contractor with who
, and who acknowledged that
he/she was authorized to execute this document. He/she ' either personally known to me or
qqueWd 1�� as valid identification.
r
WITNESS my hand and seal this day of _ /� Qty , 20 .
Nota_g�_:g
ry Public
F-80E-3-NOTARY
�?t:66lB BLgNTON;h°.0 SiON # DD 188491
February 25, 2007 Fi Netary Discount Assoc. Co.