HomeMy WebLinkAbout1505 Palmeto AveCITY OF SANFORD PERMIT APPLICATION
5 ODate: /.�,� _O -
Permit No.: -
Job Address: /----,0 S Pd - VI C-7_0 el-1115-
Permit
)-V'L5-
Permit Type: Building Electrical Mechanical Plumbing Fire Alarin/Spriolder
Description of Work: 1 � 00
Additional Information for Electrical & Plumbing Permits
Electrical: Addition/Alteration _Change of Service _Temporary Pole New AMP Service 0 of AMPS
Plumbing/Residential: Addition/Alteration _New Construction (One Closet Plus Additional)
Plumbing/Commercial: Number of Fixtures Number of Water & Sewer Drainage Lures Number of Gas Lures
o
Occupancy Type. Residential Commercial — Industrial Total Sq Ftg: Value of Work: $. � v "o
Type of Construction:
Parcel No.: (Attach Proof of Ownership & Legal Description)
Owner/Address/Phone: l ti'lU /—P/-)-( /1,1CMS /� f/ir_ �, Yet %U/l /�� `u� 3 _2 7 i
Flood Zone: Number of Stories: Number of Dwelling Units:
Contractor/Address/Phone: 2TAwn r-.`
i -&A- 3277,3X State License Nrmiber: oW 0.5:2�3c^0_
Contact Person: J i< Phone & Fax Number: ero 7 3 9: -,518'2--4-
Title Holder (If other than Owner):
Address:
Bonding Company:
Address:
ffff �
Mortgage Lender:
Address:
Architect/Engineer
Address:
Phone No.:
Fax No..
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 NO'T'ICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING 'TWICE FOR IMPROVEMEN'T'S 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 prop"t of the require )nts of Florid Lien Law, FS 713.
Signature of Owner/Agent Date �gn tureof Contract'r/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _
Produced ID
Personally Known to Me or
APPLICATION APPROVED BY: YT /6A
Special Conditions:
Print Contractor/Agent's Nainerl
ySignature of Notary -State
W Florida Date
,JO AINP M. JOHNSON . n
MY COMMISSION # Cc 921808
FARRES-
_ yr�nr v�oK�
N1110 23, 2004
Bonded Thro Budget Plotary
Services
Contractor/Agent is
PersonallyTlCnown to Me or
rt 5-0 8 t -7 �"Q:)
-� Produced ID
,%C I 1 1-22)0
Date: -�_-
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PROJECT NO.:
0013.15
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DESIGNED BY:
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CHECKED BY:
WEB
SHEET NO.
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