HomeMy WebLinkAbout1701 Russon AveCI'it . ,,{; eNFOIW PERMIT APPLICATION
Permit No.:
Job Address: %tel //$Sol✓ ��G
Date: 0 ®� .
Permit Type: ___Building Electrical Mechanical Plumbing V Fire Alarm/Sprinkler
D(,scription of Work:
Additional Information for Electrical & Plumbing Permits
Electrical: �Addition/Alteration _-Chanve of Service Temporary Pole _New AMP Service (# of AMPS )
PlumbinglResidential: Addition/Alteration . New Construction (One Closet Plus Additional)
Plumbing/Commercial:NLimber of Fixtures Number of Water & Sewer Drainage Lines Number of Gas Lines
Occupancy Type: V
Type of Construction
Parcel No.:
/ • a t,/� ,,��//
Residential _Commercial industrial Total Sq Ftg: ,, %C%_ Value of Work: $�1—
Flood 'Lone:_ Number of Stories: I,)—_ Number of Dwelling Units:
(Attach Proof of Ownership & Legal Description)
Owner/Address/Phone:_
Contractor/Address/Phone:
/n Carr,
Contact Person: t Af /—,
Address:
Bonding Company:
Address:
Mortgage Lender:
Address:
ArchitectlEngineer. _____
Address:
Title Holder (If other than Owner): _
{— f _Z-1 aJ v; — 1
Phone No.:
W Fax No..
Application is hereby rnade 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 CONDI'T'IONERS, etc.
OWNER'S AFFIDA.V!T: i certify that all or the bregoing 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 A"T"TORNEY BEFORE; RECORDING YOUR
NOTICE OF COMMENCEMENT.
NOTI0 : 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: rhanagement districts, state agencies, or federal agencies.
Acceettan�e of er is verification that I will notify the owner of the property of the requirements of Florida .Lien Law, FS 713.
cam/
Si WlIre of Owner/Agent Date :SWignatur of Contras r/Agent Date
Print Vryper/Agent s Name Print Contractor/Agent's IJa yiJ
1.fWDA �1F''tc�
�'' � %SOta�y F+uF ht �I�Ic� t•,' Fidil!l�
� �t lily i9nR� �a`Nr �;1/ l�• ^Cr6d
O�,vne'r"/Agerit Ts"%"��Persotially�Knowrf •to Me or �_'
Produced ID
signature of otar State of Florida F
May L Peterson
My Commisalon DD08=
V, wore Expires January 10, 2008
Contractor/Agent is
Produced ID .
_ n
:APPLICATION APPROVED BY:
Special Ccnditions:
r Personally .Known to Me or
Date: � ` Q 2-
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PLANS RENTED
CITE' OF SANFORD
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