HomeMy WebLinkAbout1295 W Airport BlvdP"I nk #
Job Add res.: r
Decriptiaatr
Dist: :
CITY OF SANI►ORD PERMIT APPLICATION
Date-. (Yln,e.,r ECEIVED
MAY 4ssW
0
Value
Permk Type: Building Electrical Mechanical Pluming Fire Sprinkler/Atum Pool
Electrical: New Service — # of AMPS Addition/Almration Change of Service 'TenWraty Pole
Meeban scat: Residential Nan -Residential Replacetnent New (Duct Layom & E:nergy Calc. Requuired)
PlumbloW New Comruesrcial: # of Fixtures # of Water & Sewer Lines # of Gas I lues
PlatubbWNew Residential: # of Water Ooscts Plumbing Repair -- Residential or Commercial
Occupancy Type: Residential Commercial Indust W Tota! Square Footage:
Comhrwetka Type: # of Storks: # of Dwdlig Urtdts: Flood Z w (n%1A fora re%W d for eum dials X)
Parol #: C).1-' C(' ( ) Q() t-7 " UCX(A4ncb Proof of OwneraYip do 1.1 Dacriptlon)
aaera acre all
Address: ) l ,(_ (7 ii `�.. .1 Alp, ��0. (il [ 3
Co`Mtractor Nme �iAddrwt �__ 0 rl / 'r -P , v -."F' 1r,- En CI —
1 l.\.Q • it 1 �c �Q / C.1 i' C'_ tc/ s� \ /Shite Lkesse Number. =-r (/ten ) l , '�)-o G 3
-PkarE"ds
Barring Ceaal?�rr r
Address:
MerWV Lerner b\) 11i
Addreu:
,+r+c.itetynBq�.Oer: �� - Pinnate:
Adams: Fax:
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
ua
issnce of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. 1 u de sUM that it separate
permit roust be squad for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVTf: I certify that all of the foregoing information is accurate and rut all wok will be done in congaliance 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 1MPROVEMEDTfS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTIQ: In addition to the requirements of this permit, there may be additional restrictiow applicable to this property that may be found in the public rearms of
this county, and these may be additional permits required from cher governmeartal entities such as water management districts, state agencies, or federal agencies.
Aeceptance of pemrit is vaifiadion that I will notify the owner of the property of the requirements of Florida L' , FS 713.
X
Signature of Owner/Ager Date Sigmturc bf Comnrctor/od t Date
Print Owner/Agent's Now �ontroctor/A s ame
Signature of Notary -State of Florida Date i
gnature of Notary -State of Florida oate
Owns/Agent is Personally Known to Me or Conductor/Agent is —1 P"Wv rlly Known to Me or
Producod ID Produced ID `n/1
APPLICATION APMOVED BY: Bldg:
(Ntw & ) (inilal do Doe) (1nita! & Due)
Special Conditions: -
pp KAREN M. 131NNER
MY COMMISSION # 04 265856
l'Y '�., •^ � F�P1R!»;3:RFriid,�g,2si67
1 M-MOTAW FL Pkxvy %lax" Astor; co;