HomeMy WebLinkAbout203-205 E 1 StCITY OF SANFORD PERNIIT APPLICATION
Permit No.: Date:
Job Address:3"2
Permit Type: Building Electrical Mechanical Plumbing Fire Alarm/Sprinkler
Description of Work:
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: S
Type of Construction: Flood Zone: Number of Stories: Number of Dwelling Units:
Parcel No.:
Owner/Address/Phone:
Contractor/Address/Phone:
Contact Person:
Title Holder (If other than Owner):
Address:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer
Phone & Fax Number:
Attach Proof of Ownership & Legal Description)
State License Number:
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 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.
cce ce of p t is verifi \ ion that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
xSign wner/Agent bate Signature of Contractor/Agent Date
Priinntt%Owner/Agent's Name
r
iV &, e— C,a/h2 , —/b Z
Signature of Notary -State of Florida Date
p.,, Melissa Cameron
r '_commission # DD079918
Expires Dec. 20 2005
WIi oQ Bonded Thru
O ;; %, Atlantic Bonding co., Inc.
Owner/Agent is Personally Known to Me or
X Produced ID GT (pZU L13 l (Zi
APPLICATION APPROVED BY:
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Contractor/Agent is Personally Known to Me or
Produced ID
Date:
Special Conditions: