HomeMy WebLinkAbout4300 St Johns Pkwy, k 64 - ZZU
CITY OF SANFORD PERMIT APPLICATION
Permit # : "-Z2ZJ Date: G' N-Vto
Job Address: 006 Sr Ja4itf 4,4 La j
Description of Work: Wire -�2L:tf 46"g, -
Historic District: Zoning: Value of Work: S 2300
04-3-, -W
Permit Type: Building Electrical X— Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS Addition/Alteration k 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 Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Contractor Name & Address: .)ael
(Attach Proof of Ownership & Legal Description)
Phone: 4e 7-
- State License Number: EC/3W/yV3
?hone x Pax: C1G7-32a lSLl 330 -/71f f/ Contact Person: ���� ��Y _ 7?hone: 407-#V`7
,az�
3ondinq Company:
,lddress:
Ylorigage Lender: OY/
lddress:
om rc,.s:
-[aae , ., ......- .,^;[ :c cu me 110x:. -u ,.,,:ailduu::..., :�uic�.,.... :..... ; :or.:.•r .-,[a;iae;o;: -n:: nc: ; Cr.,:r :r
.ssuance ,:i :::ermn -nd mmi ail :,,rK ::;;1 I:e perronned ::, :nue[ -,[anaards ...1 laws r:e:;u;a[:r; -'onsrruc::on in C,:is Iunsdic::un. ,:naer;;;anu [nac _ c eour..[e
oermi[ mus[ ae securea for ELIC?RICAL ✓ORK..%LUlv1BCVG.: IGNS. WELLS. POOLS, ' iRCIAC: S. 301LERS, HEATERS. TANKS, ana
AIR c;DNDITIONERS, 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 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 requ ts of Florida Li ea La , FS 7
G jorr6
Signature of Owner/Agent Date rum of Contractor/Agent V, Date
Print Owner/Agent's Name Print Contractor/Agent's Name
Signature of Notary -State of Florida Dau tore of No
tary-State of Flori Date
JO ANN ht J( MNWN
* MY C SION A DO 285622
Owner/Agent is _ Personally Known to Me or Con @9n4 tkg; Me or
_ Produced ID _ Pro?tine&4� ori ed n'N Budge Notary Services
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date)