HomeMy WebLinkAbout205 E 1 StCITY OF SANFORD PERMIT APPLICATION
aPermitNo.: 2,-551 .N Date:
Job Address: 0?0 J t /54r5 7-
Permit Type: Building Electrical Mechanical Plumbing Fire Alarm/Sprinkler
Description of Work: a o?-440oo z
Additional Information for Electrical & Plumbing Permits
Electrical: _Addition/Alteration _Change of Service Temporary Pole _New AND 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 'C Commercial _ Industrial Total Sq Ftg: Value of Work: S 00
Type of Construction:
Parcel No.:
Owner/,
Contractor/
Flood Zone: Number of Stories: 2— Number of Dwelling Units:
Attach Proof of Ownershi & Legal Description)
so ZA lFs 7 07 7- 4- 7116
O . O / Z-I 7' /Y Stat License Number: C O/S—Zgr
Contact Person: Qi! 1(60 & SO Phone & Fax Number: _ 4o7 467 SS'w AAKOO ZZf-O// 7
Title Holder (If other than Owner):
Address:
Bonding Company: / /(
Address:
Mortgage Lender;
Address:
Architect/Engineer Phone No.: - 4d? 74
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 distr' to agencies, or federal agencies.
Acceptance of t is ve ' cation that I will notify the owner of the property of the req . ements Florida Lien Law, FS 713.
Signature of Owner/ gent Date Signature of Contractor/Agent Date
Jkint Owner/Agents Name ;i;ntContractor/Agent's Name-
7002—
gnature ofNotary-S to of Florida Date tuie of Notary -State oT Florida Date
ANM M. JOHNSON
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MY COMMISSION # CC 921808
EXP'.RES: March 23, 2004
rF qy Bonded Thru Budget NoUry ServicesOFFt
Owner/Agent is Personally Known to Me or
Produced ID
Ry Po _
JO ANN M. JOHNSON
MY COMMISSION A CC 921808
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EXPIRES: March 23, 20040,11r Bonded ihru Budget Notary Services
Contractor/Agent is Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: 1 -49— Date: / — ( d'— o
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