HomeMy WebLinkAbout480 W Airport Blvd (7)b ►c\%4 6 .
Permit #
Job Address:
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Permit Type: Building Electrical
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential _
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Work: S C4?_'6Q .
Mechanical Plumbing Fire Sprinkler/Alarm Pool _
_ Addition/Alteration Change of Service Temporary Pole _
Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Industrial
Plumbing Repair - Residential or Commercial
Construction Type: # of Stories: # of Dwelling Units: Flood Zone:(FEMA form rrequired )
Owners Name & Address:p+k q may'jaAJJ / Ujcj- C6R \V t I lew la`Wfo,NCzs'
Phone:
Contractor Name
`&Address: IkkW I -A LAIL^�%�{ C 72/ IL��r�J+c 'r lt,, ��j
04 -LMA 42, LlCo .� l/i q�, �Tq.� `�2 C nB State License Number: CCQ ( � Q �+
Phone & Fa::2_ L - . Mfa � / Chi' 8Kb /-1'1 1 Contact Person: ''V 1` I C� I' Phone: SS?2 - SIG" ��b
Bonding Company:
Address: ,� r
Mortgage Lender:
Address:
Architect/Engineer: ,� 1 L!s Phone:
Address:
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.
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 ofpermit is erification that 1 will notify the owner of the pro y of the requirements of F ida Lien Law, FS 713.
t0
Signature of Owner/Agent Date Signature of tractor/Agent Date
Daniel B. t=rench
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
UTIL:
FD:
Pry ntractor/A ent' lame
D &, 206
Signature of Notary -State of FloridaDate
. SAD.WITTSTRUCK9 ....���
Commt DD0449077
Exp:r s 7f10r2009 S
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