HomeMy WebLinkAbout800 Park AveCITY OF SANFORD PERMT APPLICATION
Permit No.: ci,' 4 (1 S Date:
Job Address: U00 r 6 v r(
Permit Type: Building Electrical Mechanic/al Plumbing Fire Alarm/Sprinkler
Description of Work: k 4pL7 f /
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 jL Industrial Total Sq Ftg: Value of Work: S
Type of Construction: go / r
L Flood Zone: Number of Stories: Number of Dwelling Units:
Parcel No.:
Owner/Address/Phone:
Contact Person:
Title Holder (If other than
Address:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer
Address:
Attach Proof of Ownership & Legal Description)
State License Number: C C C 4 2 .?-w
Phone & Fax Number: _ % 7 -.7 2 2 — Elf
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 ft
3` OZ
Signature of
n /
gent Date S1 of
dow0d N• rf?S
Print Owner/Agent's Name Pr' Contra(
w-, 1 I31u2•
S' ature ofNotary-State oUlorida Date i e of
o""'• r°4 JO ANN M. JOHNSON
4 t MY COMMISSION A CC 921WB
of
EXPIRES: March 23, 2004
re 0,,,o Domed 7nru Dudpui Notary Services
Owner/Agent is
Produced ID
Known to Me or
APPLICATION APPROVED BY:
Special Conditions:
requirements of Florida Lien Law, FS 713.
GzDate
cad,
Date
Mary cgsib'ta
wse
QT % commisdon 4, 2003ExpiresAu8
dlBoned 'fhru
Aden! Bonding CO., Inc.
PF
Contractor/Agent is ersonally Known to Me or
Produced ID
Date: (- -7 - 0 Z