HomeMy WebLinkAbout1197 W Airport BlvdJ lit
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Permit # : tom �
Job Address;
Description of `York: _
Historic District:
CITY OF SANFORD PERMIT APPLICATION
U tr by d' 1,91 V—'x- II —c o ,
S- otal Square Footage b o o
Zoning: Va ue of Work: $
cqi
Permit'Type: Building Electrical
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
Owners Name & address:'_
Contractor Name &
Phone &
LA
Bonding Company:
Address:
Mortgage Lender: _
Address:
Architect/Engineer:
Address:
"- L
Fire
Mechanical Plumbing Sprinkle / i PAY1 N �
Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. Required)���
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair— Residential or Commercial
Industrial
# of Dwelling Units: Flood Zone: (FEMA form required )
G\.% ►Nee a 1%tt0 114t
r asyn five-,
ve. >ra !inn
State License Number: r �' �`' (0 D 0 01 ')-0 C3
fid Contact Person. .D V-1 Phonc: L 0 1 J'�, 1
Phone:
FAX:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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: 1 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 ofthis 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 pennits 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 of the requirements of torui5/G/}qr ie/n✓Ea/wJ FS 713.
SignatureoWwner/Agent Date Signaturc��//f`C��oaCCCtracto111VVVr/A,tent Date
f��. 1,U� b
Print Owner/Agent's Name Print Contractor/Agent's Nan e
A
Signature of Notary -State of Florida Date Signature "otary-State of Florida Date rpG�Jacquellna S Court
�y My Commission DD1525t
?of r`V Expires October 25, 2006
Owner/Agent is _ Personally Known to Me or Contractor/Agent is 'l( Personally Known to Me or
Produced ID Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
U'1.1L: FD: )9' `rJ ENG: BLDG:_4
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