HomeMy WebLinkAbout2120 E Sanford Ave (2)'P: / V
, GPermit # : - `
lob Address: _
Description of Work:
CITU OFSANFORD PERMIT APPLICATION
Date: F5� Z' — v
Historic District: Zoning:
l_/qA -_ IT r l'olal Square Footage
� p0
Value of Work: S �7J
Permit Type: Building Electrical Mechanical Plumbing � Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS Addition/Alteration Change of Scrvice 'I'cmporary Pole
Mechanical: Residential _X Non -Residential
Plumbing/ New Commercial: # of fixtures _
Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair - Residential or Commercial
Decupancy Type: Residential Y Commercial Industrial
Construction Type: # of Stories: # of Dwelling Units: Flood "Lone: (FEMA form required)
3wuers Name & Address:
71 7 n il--- S.4nl O ll dr-- _. V T -7
:oatraclor Name & Address:
'hone & Fax:
3onding Company:
\ddress:
Mortgage lender:
\ddress:
krchilecl/Engineer:
\ddress:
License Number:
�16 i Phone:
Phone:
Fax:
kpplication is hereby made to obtain a permit to do thew" and installations as indicated. 1 certify that no work or installation has commenced prior to the
ssuance of a permit and that 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
UR CONDITIONERS, etc.
)WNER'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
onstruction and zoning. WARNING TO OWNER- YOUR FAILURE TO RECORD A NOTICE: OF COMMENCEMEN'r MAY RESULT IN YOUR PAYING
'WICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
\'ITORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
JOTICE: 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
his county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
\cceptanct of pc
=4 is vC"!J98tvn that 1 wi noti r o property of the requirements of Florida Lico Law, FS 713.
Signalur�; f Owner/Agent Date Signature of Contractor/Agent Date
°•^D_`+c
Signature of Nj§0J*§Uc nT'Florida% rb
a • d CS0'_
�?•_•w�'rMU 10,• A
Owner/Ageat is '
Produced ID
.PPROVALS: ZONING:
pecial Conditions:
:ev 032006
U rIL:
Print Contractor/Agent's Name
Date Signature of Notary -State of Florida Date
e� Contractor/Agent is _ Personally Known to Me or
•C _ Produced ID
FD:
ENG:
BLDG:
� �s6C:o
CONTRACTOR REGISTRATION APPLICATION
City of Sanford
300 N. Park Avenue ♦ P. O. Box 1788
Sanford, FL 32772-1788
(407) 330-5656 or (407) 330-5660
FAX (407) 328-3859
1. Business Name
Date ? — 2 I — 0
2. Business Mailing Address
City0A55j-1L67z1?-
E
Lc
3. Business Phone 4 O — ' �� �� Fax G S- —TO O O
4. Name of Qualifier on State License W t r ✓� �� �� d S �< < ��
5. State License Classification C-' E— C— O -Si-
6.
6. State License Number
Applicant's Signature
If State Certified: Must provide a copy of current State license and occupational license;
Certificate of Workman's Compensation Insurance or Waiver Affidavit. $10.00 registration fee
will be assessed in lieu of current occupational license.
If State Registered: Must provide a copy of current State license and occupational license;.
Certificate of Workman's Compensation Insurance or Waiver Affidavit; a $2,000 Surety Bond; a
Letter of Reciprocity sent from jurisdiction the H. H. Block exam was taken; a City of Sanford
Competency Card will be issued. $10.00 registration fee will be assessed in lieu of a current
occupational license.
All Other Specialty Contractors: Must provide a Certificate of Workman's Compensation
Insurance or Waiver Affidavit; a $2,000 surety bond. A $10.00 fee registration will be assessed.
***** Certificates of Insurance shall list the City of Sanford as a certificate holder. *****
OFFICIAL USE ONLY
Control # City Registration #