HomeMy WebLinkAbout219 Hays Dr (2)Permit#:
Job Address:
CITY OF SANFORD PERMIT APPLICATION
Date: 711310c,
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Descri tion of Work: a*o aM P U r&d& Qu„ uo +oSIGW `ja Square
F ota
p Dy �1'otal Square Footage
Historic District: Zoning: Value of Work: S 5db,00
Permit Type: Building Electrical X Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS 20O Addition/Alteration � 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
Occupancy Type: Residential X Commercial
Construction Type: # of Stories:
Plumbing Repair— Residential or Commercial
Industrial
# of Dwelling Units: Flood Zone: (FEMA form required)
Owners Name & Address: L.,,cf Cis 11 9 N"3 Dir. Sa -Ard , 171 'oV II
Phone:
Contractor Name&Address: $O(jki'hp&&+ Ei Jaky�G 2012 Curry Ford PA Or• G.Mb F( W66
State License Number: E0000 i ?V2.
Phone & Fax: 467, 211 S. 7673 4V.213, &566 Contact Person: J*Sh1 /Jtux.N'e_ Phone: 407, N 5.l0 73
Bonding Company
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Phone:
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: 1 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 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 water management districts, state agencies, or federal agencies.
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Acceptance of permit is verification that 1 will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
7113)M6
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Ricl-ham J. Deese,
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
_ Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
UTIL: FD:
's
3-
MY COMMISSION II DD 300632
EXPIRES: Mardi 16, 2008
Bonded nru No" PW* UMMmNmt
Contractor/Agent is ✓ Personally Known to Me or
Produced 1D
ENG:
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