HomeMy WebLinkAbout1112 Laurel AveCITY OF SANFORD PERMIT APPLICATION
Permit No.:--Q ( Date:
Job Address:_ j J I o? /,i, G /' t o t
Parcel No.: (Attach Proof of Ownership & Legal Description)
Description of Work: %1.t,1-p0 S i /YI-i-f
Type of Construction: A 00 f6W Flood Zone:
V
Valuation of Work: $ - Y00 Occupancy Type: Residential Commercial Industrial
Number of Stories: % Number of Dwelling Units: Zoning: Total Square Footage:
Owner: 164, /r 3 f
Address: i FJ Z AC/-4. .1/•
City: %Q Ma State:" Zip: Z % j z
Phone No.: V r 7- ?8 J - ?JS6 Fax No.:
Contractor: %1 40GP /(OB
Address: rQ 0 f`-4ke av a City:
f ici„ &Z State: Zip: State License No. Phone
No.: yG 7- 2 - 9Sfi Fax No.: Contact
Person: Ar 111 M / A( Title
Holder (If other than Owner): Z, Address:
Bonding
Company: Address:
Mortgage
Lender:_ Address:
Architect:
Address:
Phone
No.: Ye l ' J2 z • "!1 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. permit
is verification that 1 will notify the owner of the property of the requirements of Florida Lien Law, FS 713. Si
rof Owner/Agent Date Print Owner/
Agent's NVne 11 Signature
of
Notary -State of Florida Date eh Gloria
Averitt My Commission
CC994617 or E-
Vres January 18, 2005 AX,Zcierx -- /- /
k 0 ;- Signatu of
ontractor/Agent Date AWV W(
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Not ry-StdW%`of7,m
u" COMM
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2004 =: _ :il aw S:
LO.:,D,,, 02771 330 5076
Owner/Agent
is Personally Known to Me or Contractor/Agent is Produced ID
FDL R4jlc --?3S- tig aProduced ID _ APPLICATION APPROVED BY:
DhFAEL Personally Known to
Me or Date: /M/d;
1L, Special Conditions: