HomeMy WebLinkAbout342 W Lake Mary BlvdCITY OF SANFORD PERMIT APPLICATION
Permit H: CIX0 - d y 31 MVV
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Job Address: _?V2_ Gil • (,4k -,F /ll/9 V 3I -Vo ,S"Fpzo 3 2 ?23
Description of Work: ODD OUTC.F7S AA/J0 P11070 cC u- Total Square Footage
Historic District: Zoning: Value of Work: S 'ZOO
Permit Type: Building Electrical
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential
Plumbiag/ New Commercial: # of fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Mechanical Plumbing Fire Sprinkler/Alarm Pool
_ Addition/Alteration V Change of Service Temporary Pole _
_ Replacement New (Duct Layout & Energy Calc. Required)
_ # of Water & Sewer Lines # of Gas Lines
Plumbing Repair - Residential or Commercial _
Industrial
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
Owners Name & Address:
Phone:
Contractor Name & Address: P ti JAIC . D 8/(101?- se" 1.101(=
Slate License Number: t= C- q
Phone & Fax: U - ? ' 049 - S Contact Person: 101W TC -*XS Ot_i Phone: S K - d 33 " 0 / S O
Bonding Company:
Address:
Mortgage Lender.
Address:
Archil"LlEagineer:
Address:
Phone:
Fax:
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. 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.
OTI E: 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.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Flo ' a Lien Law, FS 713.
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Signature of Owner/Agent Date ignalure of Contractor/Agent ate
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Print Owner/Agent's Name Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING: UTIL: FD:
Special Conditions:
Rev 03/2006
- DEBBIE BLANTON
MY COMMISSION # DD iami
EXPIRES: February25, 2007
1-e J -NOTARY
FL
t,ontractorrngen o r
Produced
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