HomeMy WebLinkAbout2720 W 25 StTA
Description of Work:
p(0- dq 9
OLP-10 01 t3 9 9
CITY OF SANFORD PERMIT APPLICATION
RECEIVED
7-7-o(�
?�.r7r71 JUL 06
!!guare-Footage
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential _
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
_J k0V
Addition/Alteration Change of Service 'Temporary Pole
- Replacement New (Duct Layout & Energy Calc. Required) 0-A_
# of Water & Sewer lines # of Gas Lines q
J Ct
Plumbing Repair - Residential or Commercial `1 !� a
Industrial $�• a`� �'�
Construction Type: N of Stories: # of Dwelling Units: Flood Zone: (FEMA form required) 3
Owners Name & Address: =2D rd 1 l R V G—K, f 6-
ju • Zola C. r. k'A-/e 1Z_ 1%/ _ Phone:
Contractor Name & Address: T cTr—_5Z.'Nh
Phone & Fax:
Bonding Company:, I
Address: 04ds
Mortgage Lender.
Address:
Architect/Engineer:
Address:
Contact Person:
State License Number:
Phone:
Fax:
Phone:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. 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: 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, an there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of it is verification that 1 will notify the owner of the pi;� the requirements of Florida Lien Law, FS 713.
Sign Owner/Agent Date Signature of Contractor/Agent Uatc
Print e / g is Name Print Contractor/Agent's Name
V
of Notary -St a ori&7 Date Signature of Notary -State of Florida Date
MY COMMISSION I OD 477136
Owner/Agent is _ ft - tWIRES: Septett26, 2DW Contractor/Agent is _ Personally Known to Me or
Produced lE „ eaidrdrhuNoraygak Produced ID
APPROVALS: ZONING: F/J 7.19-0G UTIL: FD: ENG: BLDG:
Special Conditions: Z
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