HomeMy WebLinkAbout152 Acade Way AveCITY OF SANFORD PERMT APPLICATION
Permit No.: a `f 5 (o
y
Date:
Job Address: e -J,
Permit Type: Building Electrical Mechanical Plumbing Fire Alarm/Sprinkler
Description of Work: X,2 Id e l /6/i. L d Ar G k
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
Type of Construction: 00 fF 'i Flood Zone:
Parcel No.:
Total Sq Ftg: _fferU Value of Work: S Z y0G
Number of Stories: Number of Dwelling Units:
Attach Proof of Ownership & Legal Description)
Owner/Address/Phone:-
t_
C,
7 i / State License Number:
Contact Person: /1`iS, rA,4 MCgCO/ Phone &Fax Number: _
Title Holder (If other than Owner):
Address:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer
Address:
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.
ci Q JJ4- —d.-2
Signature of Ownevot Date
War d A, Jeri-wes
Print Owner/Agent's Name
Owner/Agent is _
Produced ID
3-OL Date
11
MYCOMMISSION4CC921808EXPIRES:
March 23.2004 Bonded
Thru Budget Notary Services Personally
Known to Me or APPLICATION
APPROVED BY: ri 1' ' t- (
7 Z Date
1--) —
lJ1 Date
Commission *
CO $51644 Expires
Aug. 4, 2003 Bonded
Thru Atlantic
Bonding Co., Inc. Contractor/
Agent is _Je fler sonally Known to Me or Produced
ID Date:
I -I — 6 2 Special
Conditions: