HomeMy WebLinkAbout513 E 9 StCITY OF SANFORD PERIVL><'I' APPLICA'T'ION
Permit No : 0 12-6 7 L Date:
Job Address: i ( C( 3 F�� .
PermitType: Building Electrical Mechanical Plumbing
]Description of Work: 6"���1 �I ",_,
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Fire Alarm�Sprinklcr
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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 Numberof Gas Lines
Occupancy Type: Residential "Commercial — Industrial Total S(l Ftg: Value of Wor r y
Type`of Construction: Flood Zone: Number of Stories: Number of Dwelling Units:
Parcel No.: (Attach Proof of Ownership & Legal Description)
bwiie'r/Address/Phone:
Contractor/Address/Phone:
_ State License Number:
Contact Person: ItiOI..nt) YPhone & Fax Number,-
Title
umber:Title Holder (If other than Owng,r):
Address:• 'S) LA`, -
Bonding Company:
Address:
.Mortgage Lender:
Address -
kch*itect"/Enginee*r
ddress:Architect/Engineer 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. I understand that a separate pen -nit 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 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 be additional permits required from other governmental entities such as
water management districts, state agencies, or federal agencies.
Acceptance of perm is- et x ation that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
L44 Z_
Si� attire of Owner/A ent Date Signature o1 Contractor/Ag
ent Date'
Print Owner/Agent's Name
Si ature of Notary -State of Florida
Jo ANN K JOhI'�VSOP! .
*' �� � � MY COMMIc 510Pd # cc 921808
%arch 23, 2004
r aJ ¢ Eondcv'ihru f3uci{iet Votary Sorvicou
Owney/Agent isJ Persf'pally Known to Me or
Produced 11 )) LM L. CI L3 (, L(`d 97
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Contractor/Agent is Personally Known to Me or
Produced 1D _
APPLICATION APPROVED BY: ��_ ✓ry^f` Date:
Special Conditions: