HomeMy WebLinkAbout500 W Airport BlvdY'De \
CITY OF SANFORD PERMIT APPLICATION
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Pe ml # : p� Date: _
Job dress: %� t Ci-�e�l C V d 1 1(�t
Description of Work: OV +Z r f�aS?rC7M t Total Square Footage
Historic District: NO Zoning: Value of Work: $
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
Mechanical Plumbing Fire Sprinkler/Alarm Pool
_ Addition/Alteration Change of Service TemporaryPole
_ 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:
Contractor Name & Address:
Phone & Fax: �-' CJ (7'3/ 3b`
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Bonding Company: 1 `� f N
W
Phone:
776 ^State Licenser Number: �iL� V
Person: P11 �1 r h6: er _Phone:
Address: ,,\\
Mortgage Lender:
Address:
Architect/Eagineer: 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.
NOTI 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 itis verification I will noti the owner of e p operty of the requirements of FI rids Lien Law, FS 713.
�, `� o LV.
Signature of Owner/Ager Date Signature of ontractor/Agent Datc
Daniel B. Frena
Print O er/A Pr-nAontra r/Aggennt's Name
C o da7v".-Aa Date %—ignaturprA Date
USA D WITTSTRUCK =
gq' Comma DDOMeOTt' R
MY OMMEUDAISS ON CERNPIRES June 22, 2006 = . % 0- - -`- ---- •-- -
APPROVALS: ZONING: UTIL: FD: ENG: BLDG:
Special Conditions:
Rev 03/2006