HomeMy WebLinkAbout2201 S Oak AveCITY OF SANFORD PERMIT APPLICATION
Permit # : Vo Dater q I Ict I (a
Job Address: 21.0 ��- —Y t. ) Fay -a , F -ri
Description of Work:.TZ,emooEL. �S IDENT-1 f ( Total Square Footage
Historic District: Iv D Zoning: Value of Work: $ GOO
Permit Type: Building Electrical %/ Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS Addition/Alteration X Change of Service Temporary 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 X Commercial Industrial
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
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Owners Name & Address:-D(�V I'O l t� P. lazi&. , iv 0 Lakt 1 YA �L,-_ YJ 1' 1 V -e , gSaV1C:W-a , F_t. 3Z,% -j
Phone:
Contractor NWe & Address: I 9 Low L— 1If 3 S . e_
6_,alilt't7Yd -1 ld State License Number: g• E cocoZd1 l I
Phone & Fax: Lin.'b2s.-iyto� 4-7 L9 ContactPerson:�.
QIZ) GMIT-rf Phone: LJtT7.3z$.'1Z1eo * 113
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
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. 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 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 applicakilt
o ' 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 ' m gemegt districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements oflflUri(A A Law, FS 713. 1
Signature of Owner/Agent
Date Signature ofT!bntfacti r/Agent Date
Print Owner/Agent's Name Prinl c ge 's Name
L ,10t
Signature of Notary -State of Florida Date Signat re of Nota tate of Florida Date
,AY Putt Cheryl L Smith
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My Commission DD243250
T
r�d� Expires August 20, 2007
Owner/Agent is Personally Known to Me or Contractor/Agent is X Personally Known to Me or
Produced ID Produced ID
APPROVALS: ZONING: UTIL: FD: ENG: BLDG:
Special Conditions:
Rev 03/2006