HomeMy WebLinkAbout106 Country PlCITY OF SANFORD P�ERWT APPL2CATION ..-�
Permit No.:� l/_ Date:
Job Address:
Permit Type: _X_ Building llectrical Mechanical ` Plumbing Fire Alarm Sprinkler
Description of Work: 4t7`OW-5 t` 1.
Additional Information for Electrical & Plumbing Permits
Electrical: Addition/Alteration kChange of Service kTemporary Pole kNew AMI' Service (1# of AMPS
Plumbing/Residential: _A�O Addition/Alteration __New Construction (One Closet Plus Additional)
Plumbing/Commercial: Number of Fixtures ' Number of Water & Sewer Drainage Lines ' Number of Gas Lines X
Occupancy Type: Residential Commercial _ Industrial Total Sq Ftg: _ Value of Work: $ 35' :7_ �ig '
Type of Construction: W191d Flood Zonc:,��- Number of Stories: Number Number of Dwelling Units: J_
Parcel No.:, /1 ff( (Attach Proof of Ownership& Legal Description)
Owner/Address/Phone; / il%W9. A, Y'1CA)Jw/° x) 1,96
Contractor/
State License Number:
Contact Person: f�`�/`"��nl ` Phone &Fax Nu►txbe►: _a jj_T
Title Holder (If other than Owner): 5
Address:
Bonding
.Address:
Mortgage
Address:
Architect
Address:
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 inforrnation 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 PROPER"T"Y. 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 bo,'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 pr4erty ofJ i� r�quireAe#Vol/Fl4ida Lien Law, FS /13.
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of otary-State of Florida Date S
of Contractor, Agent'—i/' v v "'V " Date
�L� 14
ractor/Agent's Name
-3_ fir.
Date
m Commission #` WOMB
la
AMYXANDERSExpires Dec. 20.7005
MY COMMISSION # GC 786976 •oFOF F`a?:Bonded TbM
EXPIRES: Match 8, 2002Atlantic BondingCo.,Ine,° Bonded Thru Notary Public Underwriters
Owner gent is r.-� ersona y own to Me or Contractor/Agent is _ _ Personally Known to Me or
T Produced ID _ _ _ Dr.Produced ID����
APPLICATION APPij VED BY: 6C% _ r- . ; _ Date:' , `U 5
Special Conditions: __ <