HomeMy WebLinkAbout113 E Lake Mary BlvdCITY OF SANFORD PERMIT• APPLICATION
Permit # : �+'/ Date:2/J ZD 46
Job Address: lot -13 C-- i-aice, &4"tt 81 t•C/
Description of Work: Add ft e c-%& i c #4 t: ,'# tL VI C C To // 3 • Total Square Footage
Historic District:
Zoning:
Value of Work: S 2 0 0 0 qv
Permit Type: Building Electrical L#-- Mechanical Plumbing Fire Sprinklcr/Alarm Pool
/F % /01 3 ,
Electrical: New Service - # of AMPS S A Additiort/Alteration V Change of Service Temporary Pole
Mechanical: Residential Non-Residcntial Replacement Nev (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines N. of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair - Residential or Commercial _
Occupancy Type: Residential Commercial V Industrial
Construction Type: _� # of Stories: O # of Dwelling Units: Flood Zone: (FEMA form required)
Owners Name & Address: yv k r / k t: a ✓ S Q
Phone:
Contractor Name & Address: Nr oA." a diir� Fa tea-!
%X 26 toz ALIVit7 State License Number: �� / 70 /? Z Y, 9
Phone & Fax: C7 S/ —�'bI G S'/-- .f$- Contact Person: _)AIP/trw�t Phone: V07 -J-1k —.rV/0
BendingCompauy: gro-7-e-4&4h.,
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
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 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 1 will notify the owner of the property of the requirements of Florida Lien Law, FS 713
Signature of Owner/Agent Date signaure6econtractorraent Date
Print Owner/Agent's Name Pri ntracto gent' Name
Signature of Notary -State of Florida Date Signature o N e of FDLL
PV�e
MY CO109491
EXP2007
1.100,N TARY soc Co.
Owner/Agent is _ Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID _ Produced ID In I- It p I
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
UTIL: FD:
ENG: BLDG: