HomeMy WebLinkAbout226 Town Center CirPermit # :
Job Address:
Description of Work:
Historic District:
-71-own
RECEIVED
CITY OF SANFORD PERMIT APF;LIC'ATION MAY 3 0
///� 7 p '•
Date:
/ _
Zoning: _ Value of Work:
Permit Type: Building Electrical Mechanical Plumbing _______ Fire Sprinkler/Alarm Pool
Electrical: New Service – # of AMPS —, Addition/Alteration _ Change of Service __ Temporary Polo
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Gnergy Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets
Plumbing Repair – Residential or Commercial
Occupancy Type: Residential __ Commercial _ Industrial Total Square Footage:
Construction Type: # of Stories: It of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Contractor Name & Address:
Phone &, Fax: —�� i ✓�<)C) t%�7' ��S %/5'L7 Contact Person:
Bonding Company:
Address:
Mortgage Lender:
Address:
(Attach Proof of Ownership & Legal Description)
Phone:
State Lice"e Number: GUe _ �> ()CJIi/20O
?fl� t� un (c Phone: /y7- Z3S �lZt�p
ArchitecrlEngineer: Phone:
Address: 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 most be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
Alit CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify 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 TO OWNER: YOUR FAILURE •1'O 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 13EFORE 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 or the requirements of Florida Lieu Law, FS 713.
Signature of Owner/Agent Date D � Signatur fConuactor/Agent Datee
Print Owner/Agent's Name
Signature of Nohtry-State of Florida Date
Owner/Agent is — Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg: —�4 )1 1 ""--, g:
`(initial ci Date)
Special Conditions:
A
ctor/Agent's Na he
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' No a State Plori is
,Ay q, Ellen L. Harris
Contractor/Agent is _ Personally Knows, J% My Commission OD217997
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