HomeMy WebLinkAbout500 W Airport Blvd (4)CITY OF SANFORD PERMIT APPLICATION
Permit #: C/`0. .1 5S
Job Address: `Xo0 W . Npel
Description of Work: KP m ale R h e
Historic District: Zoning:
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
Construction Type: # of Stories:
Date:rA 2w`x'.
�1 k Total Square
e�Footage �C4
Value of Work: Co
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
Plumbing Repair – Residential or Commercial _
Industrial
# of Dwelling Units: Flood Zone: (FEMA form required)
Owners Name & Address: _ �� �O.a-t �.jC��� C_ Dlpr
Phone:
Contractor Name & Address: O-hC10.'Z2-n It �,\ Ae cs , In r q q
State License Number: SC "]d S Lk 17 /
Phone & Fax: 3S - 5 / Contact Person: �t Q—k .VNA-t.t. Phone: 3Sa• \te- (L��¢
Bonding Company: N Ir4-
Address:
Mortgage Lender: fPt
Address:
Architect/Engineer:
Address:
Phone:
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: 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 pq(glit is
's
_ Produced
will notify the o,per 9f the property of the requirements ? o
,VJwffla Lien Law, FS 713.
O ��
Date SigrAture of Contractgr/Agent Date
�r,FAMWINTT=a',':,'V rm%�
U7
C17td ASSION EXPIRES ung rye Comratr OD0449077
JUI l3 ?...2010 E 11rye 7110,2009
Me or
APPROVALS: ZONING: UTIL: FD: ENG: BLDG:
Special Conditions:
Rev 03/2006
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