HomeMy WebLinkAbout2103 S Oak AveOf --3-3y9 CITY OF SANFORD PERMIT APPLICATION
Permit # : (02 S 6 — G
/ Date: ZG —V
Job Address: 2/0 3 ,S. QG-fC atm. �G.ytr!/Yd F[ 3 Z 7 7 /
Description of Work: &eLa U .2 " G'u.Zu• I n",r
Historic District:
Zoning:
Value of Work: S Sft -JL
Permit Type: Building Electrical X Mechanical Plumbing Fire Sprinkler/Alarm Pool _
Electrical: New Service — # of AMPS ' Addition/Alteration Change of Service 12LA OTemporary Pole _
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. 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:
# of Dwelling Units:
Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address; LQ M -A. GUTkr;a ,2/G3 ,/O ZUA �QeA--, Tagej a( �e-
Phone: Sox- o 3 3 o
Contractor & Address:>� F. ` �' Zr L'L �,t�L Dtt,.:p
t^'`�^"" ,,/, r a-73 State License ;Number: �i4/lCan/w3
?hone ;c Fax: iii? 3LL-Ysrfz 336-I'X f/ Contact Person: ?hone: #V7-P/7"0Z1
3onding Company:
,\ddrebs:
Mortgage Lender:
Address:
-.resu[ecv! ;;:-enter: one:
•.aorc,s: •.
Maau ; ..a- ..... ,.:[ :_ :u Me wnr .: :>:ailaua: :nuicc..... cr.uy [. :rn:..r .->.aaa[;o;:.... .;ii: ,,_n.cr, , C.r .; ...
:ssuance -,. a cerm:::.nd.nar ail , nm •::oi Le per:ormed :-nue[ z[anaaras :Maws ra_uiac:r .ans[n:r.:on in ::isjunsaic:iaa. :..nuer.:wnu r.:at _ :zp,r[z
Per•mu mus, ;e secured for ELECTRICAL WORK. LI;11413ING. -IGNS, '.YELLS. POOLS. FiiRNACES. 301LERS.:JEATERS. TANKS. una
AIR 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 TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYINSr
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 then: 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 of the5guature
' menu of Florida Lien Law, FS 713.
Sigaature of Owner/Agent Dau Dau
Print Owner/Agent's Name Print Contractor/Agent's PaT
e
Oj
Signarure of Notary -State of Florida Date S' No SS f Dau
-r 4.4ft AI[� N
r
MY CONI!SI it DD 285822
EXPIRES: March 23, 2008
Owner/Agent is _ Personally Known to Me or orfA
&k gat is' �Cflsiiit'bll�XMwn to Me or
_ Produced ID _ Produced ID
APPLICATION APPROVED BY: Bldg: Zoning:
(Initial & Dai )
Special Conditions:
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)