HomeMy WebLinkAbout321 S Magnolia AvePermit No.:V
Job Address:
Permit Type:
Description of Work:
LOQ9
CITY OF ANIi'MD IT, R.lV>IT APPLICA.TIOaN
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Vznl'ec'
Date:
Building /Electrical A/—
l Mechanical Plumbing Fire A/larur%Sprinkler
i7-%�/ymy", /J i^i`� d,� DA'/'r S //d.11 � ����rn/`4/`it� 1111111-. a.�'/ s /"w!!//I.
Additional Information for Electrical & Plumbing Permits
Electrical: Addition/Alteration _Change of Service -Temporary Pole ____New AMP Service (# of AMPS
Plumbing/Residential: —Addition/Alteration New Construction (One Closet Plus Additional)
Plumbing/Commercial: Number of Fixtures Number of Water & Sewer Drainage Lines Number of Gas Lines
Occupancy Type: /Residential _____Commercial _— Industrial Total Sq Ftg: ______ Value of Work: $ %Qi oye. "C'
Type of Construction: _ aAmt Flood Lone: Plumber of Stories:c l i Number of Dwelling Units: W
Parcel No.: (Attach Proof of Ownership &Legal Description)
Owner/Address/Phone: `7JPi//a L .� 1, Jp ado. -�i&'/ (Attach
% A)"'11s
Contractor/Address/Phone: f " //' J�, 4)
L State, Liccuse Number: �lc'.0 .Q� 12 --
Contact Person: , YICi Ate,,&{r>�-�'/_$. Phone c�C Fax Number: _ ZSu' . �S— - ''U U
Title Holder (If other than Owner):
Address:
Bonding Company:—
Address:
Mortgage Lender:T __--
Address:
Architect/Engineer _/�'1/ ,r1 ~ v Phone No.:
Address: _ 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. 1 understand that a separate permit must be secured for ELECTRICA-L WORK, PLUMBING, SIGNS, WELLS,
POOLS, FURNACES, BOILERS, HEATERS, TANKS, and ATR 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 FINANCINQ� CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR.
NOTICE OF COMMENCEMENT. II
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 requirements of Florida Lien Law, FS 713,
Signature of Owner/Agent Date SiCon actor/Agen Date
Print Owner Agent's Name
Signature of Notary -State of Florida Date
Owner//fit is Personally Known to Me or
Produced ID
Print e titractor/Agent's I\Kme
816'at of NotaFT-Z—Stata of Florida
� + °� SAE�INA J, DAVIS
x Notary Public, State of Florida
My comm expires Mar. 1, 2005
No. DD005811
Date
'actor/Agent is.Personally Known Me or
Produced ID --i5UZ,(..66C C.0 � G -e•
APPLICATION APPROVED BY:
Special Conditions: -k -/0e ��(, ,� -F:z ,, ,_
Date: q T oj--
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