HomeMy WebLinkAbout119 Kaywood DrM-0
CITY OF SANFORD PERMIT APPLICATION
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Permit # : I -0 Date: (A
Job Address: I I Q 4 u�00� DJ?.
Description of Work:
Total Square Footagc
Historic District: Zoning: Value of Work: $ 1 J400 .OIJ
Permit Type: Building Electrical _�—_ Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS Addition/Alteration , - Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbiogl 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 —1---cornmercial Industrial
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
Owners Naz
a & Address: 1
t.J coo_ d Phone: 4c)-)— 3a3 - 300
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Contractor Name & Address: r?n c 4.= �� —� C _ n_— _
I oct ccx--,-yv.o�t;,. S }� rte. State Wmnse Number
Phone & Fax: Contact Person: Phone:
Bonding Company:
Address:
Mortgage Lender.
Address:
Architect/Eagineer. Phone:
Address: Fa::
Application is hereby made to obtain a permit to do the wort and installations as indicated. 1 certify that no work or installation has commenced prior to the
issuance ora permit and Ural all work will be performed to meet standards of all laws regulating construction in this jurisdiction. 1 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.
Imo: 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 r management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requ' is f Florida Lien Law, FS 713.
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Signature of Owner/Agent Date r66w&-tractor/Agent I Dkte
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Print Owner/Agent's Name Print n actor/Agent's Na
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Signature of Notary -Stale of Florida Date Signature o otary-State of Florida DateOwner/Agent is Personally Known to Me or Contractor/Agent is �Personally Known to Me or Produced ID Produced IDre
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APPROVALS: ZONING: UTIL: FD: ENG: BLDG:
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Special Conditions: Z g o
Rev 03/2006 o
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