HomeMy WebLinkAbout111 W 12 St 06-3046 (O l 0— CFFY Of SANFORD YERMCC APPLICATION JUl
7� // o� Date-._ GYh� ZQ�
Permit # :� CJ �"_l.A
Job Address: U'`f' 1Z+w_G�C��i
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Description of Work:
JJ �l~(1_GfQi� R�LLl1h �� it fI t�Yt_Total Square footage
Historic District: Zoning-- ���i -__ Value of %Vork: $
Perinit Type: Building _ ✓"r -- Electrical _- Mechanical Pluntbiuk, _ - - Fire SpiinklcdAlaitit _ Enol _ --
Electrical: New Service -- HI of AMPS Addition/Alteration Change of Scrvicc 'I'cwporary Pole
Mechanical: Residential : _• Non -Residential
__ Replacement
ued)
New (Duct Layout & Energy Calc- Ilequ
Plumbing/ New Commercial: f/ of Fixtures -
11 of Water & Sewer Lincs___
_ U of (las Lincs
Plumbing/New Residential: 11 of Water Closets
Plumbing Repair - Kcsidential or Conuncrcial
Occupancy Type: Residential U/ Commercial
Industrial
_.
Construction Type: Hof Stories: _ _
11 of Dwelling Units:
Flood zone: (FUMA form required)
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Owners Name &Address: YI i w�`
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t� s 'C> r e l
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Yht�ne ��t"
Contractor Name & Address: -
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State License Number:
Phone & Fax: _----, -._-
Contact Person:_
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Bonding Company:
Address:
Mortgage Lcnder:
Address:
Architect/Eugiaecr' _ - - --- -
- -
- - --- Phone' --- - — — -
Address: _
Fax:
Application is lterchy made to dbtain a permit to do the work and installations its indicated. 1 ccitity that no work or installation has comotcuccd pt iur to the
issuance of a pemnit and that all work will be performed to meet standards of all laws regulating eonshuction in thus jurisdiction. f understand that it separate
pcmtit must be secured for ELI CFRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, 11FATERS,'FANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: t ccitily that all ofthe Foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning- WARNING'FO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CONIMEMEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPKOVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CON.SUTA f WITf h YOUR LENDER Olt AN
ATFORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMEN'L
NO'1TCE: In addition to tine requirements of this permit, there may be additional restrictions applicable to this property that may be found ill 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.
, -, - r � }e owner of the property of the rcttuircmcnl" Of Flotilla I icn Law F> 7! S.
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Acceptance o`pe �[ is vr.rific�`� ry �to,t, tit .- .r-- -- - ��-�- - ---- --- - - _.—
St g Date
� h mature oFUwner/ en G�fi St nulurc ut ( mtC iitclor/A onl Dale
Ag ;`�t,,•�� `S <:C t,
Signature of taryl
1 -800 -3 -NOT
Owner/Agent Tc s -t
_ Produced 11)
APPROVALS: ZONING:
Special Conditions: _-- ---+ -.,
Rev 03/2006
DEBBIE BLAi�TOiV
MY COPJiPA1SSI0td DD 1 t;Psl91
EXPIRES: February 25,20T/
AY FL Notary Discount Asscc. Co.
nally-Knowmto-Mc`u
UrIL: FD:
Print Contne.un/AgcuCs Naute -- —_
Signaluic of Nutxry-tato of Florida Dalc
Conlracloc/Agcnt is Pcisonally Known to Mc or
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