HomeMy WebLinkAbout129 Club Rd (2)Permit 9: (0' 2723-
Job Address: j—
Description of Work:
Historic District _
CITY OF SANFORD PEKMI'1- "PULA l IU14 /j � 12f—
I Date: ��— 7 tF'^
il//G c ryr t.� 1. / ` -------- _
Zotdow Valu of Work:
Footage
Permit Type: Building Electrical _-Y'— Mecbanicai Plumbing Fire SpdnM- cdA)arm Pool
Electrical: New Service — # of AMPS % OC Addition/Alteration Cbange of Service Temporary Pole
Mechanical- Residential Nondtesidential Replacemeat New (Duct layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Futtures # of Water & Senver Lincs # of Gas Lines
Plumblug/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial ,.�— Industrial
Construction Type- # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
owners Nnme &
& Addrm:
% /n /-'1 61 — C F Vt
Phom L/G•7— ?2 7-
5 A N C:2r4 77 77 / state Licensenumber: —Gi
'Z — 6r -72i - contact Pertroa
Phone & Fa>~ �G 7 — ai�i t; k Sc %Q ti L. 17 Phone yG
Boudlug Company: �-
Address:
Mortgage Lmder
Addrers
Ambitecr/Enghreer: Phone:
Address:
Far:
Application is hereby made to obtain a pemtit to do the work and installations as indicated. 1 catify that no work or installation has commenced prior to the
issuance of a permit and 1W all work will be perfomud to matt standards of all laws regoladvg rartsamction in tbh jurisdiction. I rmderstand that a separate
permit must be seamed for ELECTRICAL WORK, PLUMBING, SIGM WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc. '
OWNER'S AFFIDAVIT: I certify that all of the foregoing icdbmtation 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 COMiNQ NCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR SeROVRASNTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COM OIENCEMENT-
NOTICE In addition to the requiremags of this pernit, there maybe additional restrictions applicable loft property that maybe found in the public mwr& of
this county, and there may be additional permits requited from other governmental entities stmt as water manage iem disWM state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the
Signature of Owner/Agem Date
Print OwnidAgeWs Name
Signeture of Notary -Soft of Florida Date
Owner/Agent is_ Personally Known to Me or
Produced lD
Signa f Contractor/AlVint
(c h
09 10 Sd� UL- Zo
Print ContractodAgeWs
7 21•e6
�� pVPfdtl Date
* MV COMMIS5ioN t DD 285622
* EXPIRES: March 23,20
Bonded TTeu B/ Notary Senr
as
ContraaodAgent is (� Known to Me or
Produced ID �/
APPROVALS: ZONING: UTIL FD: ENG: BLDG:'W
Special Conditions:
Rev W&M