HomeMy WebLinkAbout215 Avocado Ave (2)Permit
CITY OF SANFORD PERMT APPLICATION
Date:
Job Address:
Permit Type:
Description of Work:
Electrical Mechanical Plumbing Fire Alarm/Sprinkler
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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: lResidential6ommercial _ Industrial Total Sq Ftg: 2Value of Work: $0
Type of Construction: Flood Zone: Number of Stories: Number of Dwelling Units:
Parcel No.: (Attach Proof of Ownership & Legal Description)
Owner/Address/Phone:
Contractor/
State License Number: GCCOS 7767
Contact Person: Phone & Fax Numbert?9A 2 2, — % % q a
Title Holder (If other than Owner):
Address:
Bonding Company:
Address:
Mortgage Lender:
Address:
ArchitecVEngineer
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 ofall 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 ip 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.
Acceptan ofpermit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. clAlog,
Signature
of Owner/Agent - Date _ Signature of tractor/Agent Date Ae`
w, ? , G?o41,C- A,9 ep-IJ) Y7 A -IQ Is ) Print
Owner/Agent's Name Print Contractor/Agent's Name 01
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g iatu(p otaRiWate of florida Date gnatur .ofllQtary-Stat f_Florida Date koV
n •, ameron ° JO
ANN M. JOHNSON a° " co # DD07 918 r, ` EXPiM
Der 4 • MY COMMISSION # CC 92IN8 per° -
Bonded Torn , . EXPIRES: March 23, 2004 i14(miZ`` Atlantic Bonding co. Ine, Fornoa BWidldThuau , _ .1 Na.ry Servicsy Owner/
Agent is _ P ,
Yroduced ID Personally.
Known to Me or APPLICATION
APPROVED BY: r
MCon
ctor/Agent is Personally Known to Me or Produced
ID Date: '
T r
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Special
Conditions: