HomeMy WebLinkAbout1002 Poplar Ave 04-2061 (change out)CITY OF SANFORD PERMIT APPLICATION I
Permit N: 0q– 2 o 6 ( Dale: — a
Job Address: L I/ 0 2M� f f/ -P–
Description of Work: t� O's Total Square Footage t
Historic District: "Ironing: Value of Work: S re 0 t
Permit Type: Building Electrical V- Mechanical Plumbing Fire Sprinkler/Alar 11001 _
Electrical: New Service – N of AMPS �d Addition/Alteration Change of Service �cmporary Pole _
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: N of Fixtures N of Water & Sewer Lines N of Gas Lines
I
Plumbing/New Residential: N of Water Closets Plumbing Repair – Residential or Commercial
Occupancy Type: Residential Commercial Industrial
Construction Type: N of Stories: N of Dwelling Units: Flood Zone: (FEMA form required)
Owners Name & Address: /
Phone: `C d 7 % O%
Contractor Name & Address: r in °� � � � � L .7 re r` ?"
State License Number: 'E' d 00 ( /� 4/O D p
Phone & Fa:: cl d ? :)2-t Z d G G Contact Person: Ea-. a K K t� r ll Pr►YPho.e: CG
Bonding Company:
Address:
Mortgage Leader.
Address.
Architect/Engineer: 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 10 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: I certify that all of the foregoing inforrnalion 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 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 distri agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requiremen F FS 713.
7- )—d
Signature of Owner/Agent Date Signature of Contractor/Age. Datc
.�i
Print Owner/Agent's Name Pri Co Ira r/A is Name
Signature of Notary -State of Florida Date Signature ofof a of Fls�da`IE BLAWON e
MY COMMISSION* DD 165011
EXPIRES: February 25.2007
1.800-% pTARY FL Ncmry DleoOunt Anne. Co.
Owner/Agent is _ Personally Known to Me or Contractor/A y nown o e or
Produced ID _ Produced ID
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APPROVALS: ZONING: UTIL: FD: ENG: BLIA3
Special Conditions:
Rev 03/2006 + 0 J