HomeMy WebLinkAbout480 W Airport Blvd (6)Permit #
Job Address:
c)(0 - Q 1-413-1—
Description
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Description of Work:
Historic District: —1
CITY OF SANFORD PERMIT APPLICATION
Date:
Permit Type: Building Electrical
Electrical. New Service — # of AMPS
Mechanical: Residential Non-Residcntial
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Mechanical Plumbing Fire Sprinkler/Alarm Pool _
_ Addition/Alteration Change of Service -fcmporary Pole _
Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Industrial
Plumbing Repair — Residential or Commercial
Construction Type: ` te%�� � D H of Stogies: # of Dwelling Units:: ^ Flood Zone: y,�(FEMA form required)
Owners Name & Address: ^1 H1 SSriyri t IQ2I�i LOY8l_7 A�
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Phone:
7C, r/ O Slate License Number: k V I
Contact Person: Q( R\f ,h ker Phone:
Address:
Mortgage Lender.
Address:
Arcbitect/Engineer: 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 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.
TICE: 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 ' erification that I will notify the owner of the pro y of the requirements of Flor a Lien Law, FS 713.
_46 ti ?t)IR
Sign ure of Owner/Agent D to Signature of Contractor/Agent Datc
Daniel B. French
APPROVALS: ZONING:
Special Conditions:
Rev 038006
UTIL:
FD:
PrintXontractor/AgentI Name `
(1 \\ 1/At J
D WITTSTRUCK
Comma OD0449077
Ex;ir s 7/104009
Bonded thru (900)172-4i
ENG:
Or
BLDG: