HomeMy WebLinkAbout3031 S Mellonille AveV+e�'
CITY OF SANFORD PERMIT APPLICATION
-Permit#: mea - 34 5 3 Date: -ate
JobAddress: Z0 J1 Sc 1Mgioo\)Ill`ac %'a7'7c3
Description of Work: C_4 I C&•�6 ae-4- eAkv^r e—iio_Total Square Footage
Historic District: Zoning: Value of Work: S
Permit Type: Building Electrical Y_ Mechanical Plumbbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration XChange 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 Plumbing Repair — Residential or Commercial _
Occupancy Type: Residential Commercial / Industrial X
Construction Type: # of Stories: I # of Dwelling Units: Flood Zone: (FEMA form required )
Owners Name & Address:
Name & Address:CIPOA s r
Phone&Fa:: fa(.* -S-7t/
Bonding Company: /Eek 4
t �'v 1100 t CIe- veIQM SIv
Phone: 44-7
5� lL 1381 Made- Ave_
State License Number: 9— V- I J o 1 J 1 4/ _7
ContactPerson: Acr O n Phone: voi KO L - % 5 -
Address: Address:
Mortgage Lender: 1J A
Address:
Ambitect/Engineer: 14 �A Phone:
Address:
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 mea 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: 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.
NOTICE: In addition to the requirementsof this permit, there may be additional restrictions app ble to this
this county, and there may be additional permits required from other governmental entities suc water mar)
Acceptance of permit is verification that I will notify the owner of the property of the
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Signature of,Qwner/Agent Date
17c oLne. (_ rC bQ (�
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mer is Name
Signature o otary-State of Florida Date
PHYLLIS I. GIBSON
N MY COMMISSION #DDOn M
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APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
UTIL: FD:
that may be found in the public rwwds of
districts, state agencies, or federal agencies.
x, FS 713.
Date
Name
M
Signature of I*Iary-State of Florida Date
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