HomeMy WebLinkAbout1090 E 1 StCITY OF SANFORD PERMT APPLICATION
Permit No.: 5Date: 1-1-7 —zoo Z.
Job Address: Q 15 I ST 5` r eeJ
Permit Type: Building Electrical Mechanical Plumbing Fire Alarm/Sprinkler
Description of Work: Remove. E y 1 S Tl IV G S H / N G L ES / 1rELT Ayew S Fil NG LES
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:yResidential _Commercial _ Industrial Total Sq Ftg: ;7,, 570 0 Value of Work: S$Z 0 00.
Type of Construction: ioyv O Flood Zone: Number of Stories:_ Number of Dwelling Units: .2
Parcel No.: (Attach Proof of Ownership & Legal Description)
Owner/Address/Phone: %/ Q LJ Tt— t e_S ft -S S 1 DA1 I D 0 0 E l r SaN Fy iCD FL
t7'7 3z3 343
Contractor/Address/Phone: t C 471 A Rri L• S EE 000 Q D G v i a C'r, SAN'P0R D F L,
Contact Person: T% 0 N H
Title Holder (If other than Owner):
Address:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer
Address:
State License Number: C C CD S 7 3 4
Phone & Fax Number: -i D 7 3 Z 3 3 q 30 Ex ?$ 7
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 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 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 property of the requirements of Florida Lien Law, FS 713.
e- /-16 -0"--
Signature of Owner/Agent 7, Date
aterP
Wo
Owner/1-1 1L
Produced ID
oL
TIMOTHY W. MEISEL
MY COMMISSION* DD058631
EXPIRES: NoMMW 1.2W5
AY FLNotan SeMw a 9mdnp. M0.
Personally Known to Me or
APPLICATION APPROVED BY:
Special Conditions:
z4./ Z- C'- /-/
7-07-
Signature of Contractor/Agent Date
2l ff42D . SF ---
Print Contra Name
S atur of Notary -State of Florida Date
KENNETH PAULFROST
MY COMMISSION #t DD 049754
EXPIRES: September 22, 2005
i400,. OTARY FL NOIYy SWV" a 9aWi p, kw
Contractor/Agent is Personally Known to Me or
Produced ID
Date: ( — \ 3 ^ O Z
iw