HomeMy WebLinkAbout4155 Anderson Blvd^ CITY OF SANFORD PERMIT APPLICATION
Permit #: �J Date: e.
Job Address:`/l55
&I`y"
Description of Work: �`� !AOl
p �- _AA.sno04L— Total Square Footage
4 d
Historic District: Zoning: Value of Work: $ d 6o
Permit Type: Building Electrical Y Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS 100 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 Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
Owners Name & Address: AA" L Ay" 140 An 6-5
5e%NA1,,e ,E 0A 0&A# 406 Phone: 4/0 8%`, 7S SS P�
^Contractor Name & A
gs Address:R F_ di/ s i e� 2 �1
d l�riV FaPT/y to State License Number: ir`I> od lQ7 i7
Phone & Fax: Y0 7" 4 / 7$ Contact Person: 0 Phone: Y07'ig %
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: 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 M 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.
Acceptance of permit is verification that 1 will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
.J
Signature of Owner/Agent Date Signature of Contractor/Agen Date
Print Owner/Agent's Name Priut-Contractorl4gent's Name
Signature of Notary -State of Florida
Owner/Agent is _
_ Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
Personally Known to Me or
UTIL:
Date Signature ol N " - e of 04MIt OU" I wt`bate
My COMMISSION # DD ISMI
EXPIRES:,February 25,20(Y7
1 -800.3 -NOTARY a :f tgtmy Dlwot t Assoc. Co.
FD:
Contractor/Agent is Pe so ally Known to Me or
Produced ID
ENG:
BLDG: