HomeMy WebLinkAbout219 Town Center CirPermit
.Job Address: z I UtJA om
Description of Work:
Historic District: _ zoning:
RECEIVED
CITY OFSANFORDPERMIT APPLICATION JUN 200
Date:
Value of Work: S
Permit Type: building Electrical Mechanical Plumbing Fire Sprinkler/Alann Pool
Electrical: New Set -vice – # of AMPS Addition/Alteratio u —_— Change of Service Temporary Polo—
Mechanical: Residential _— Non -Residential Replacement New_— (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines I/ of Gas Lines
Plumbing/New Residential: # of Water Closets _ _ Plumbing Repair – Residential or Commercial _
Occupancy Type: Residential Commercial K Industrial _ Total Square Footage:
Construction 'Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
U �l�''Contact Person:
(Attach Proof of Ownership & Legal Description)
Phone:
Number:
Phone:
Fax:
%7- 2 3s--1/2 4.,
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. 1 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 [MPROVENIENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT' WITH YOUR LENDER OR AN
ATTORNEY 13EFOKE 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 pemnits 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
7of Florida Lien Law, FS 713.
Signature of Owner/Agent Date Signature of ( ntractor/Agent Date
Print Owner/Agent's Name Print C+ ctor/Agent' ai e
W10
Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date
sN Ellen 1.Harris'My Commission Dp217997
Owner/Agent is -- Personally Known to Me or Contractor/Agent is f eral14bwnEtfrfs August 16, 2007
Produced ID Produced ID
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APPLICATION APPROVED BY: Bldg: \ T V Zoning: Utilities: �/ I D _
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(Initial & Date) (Initial & Date) Initial & to (InchdfDttc) •
Special Conditions:
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'NOTICE: Thio drawing and the data thereon 3holl not be duplicated, uoed, or diocloead to athore for - - - -
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