HomeMy WebLinkAbout500 W Airport Blvd (5)Permit # :—�
Job Address:
CITY OF SANFORD PERMIT APPLICATION 7
Date: / Zc, Ze_
Description ofWork:Vc2_wn6> W- Ca �'�Cl (-�7\QI IF Total Square Footage Llc5 Sc%l) `GAAs11
Historic District: N D 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
Construction Type: # of Stories:
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{&},Adddress: "t -kV— \ 0. R7 n 'fir l_l.L ,'��V \\\QQ P l�l_Yr t✓S t�1-[�'Y�3 .
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Contractor Name'&Address:
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Qy -+2-Lk2� ,, T, e PAn t _ 3oP State License Number: c cf_ Ia);) ` L Q Ci 9
Phone & Fax:3S2• ags •L•11g'?5 12585 . 1219 1 Contact Person: %CAA Phone: S? • S\ ILQ - OZ&\.v
Bonding Company: N I k
Address:
Mortgage Lender: N
Address:
Architect/Engineer: N Pt 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: 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 ' erjii alio t ill notify the ow r o he property of the requirements of Florida Lien Law, FS 713.
61
atur er/Agent Date S' nature of Contract r/Agent Date
Pri caner/Amtm,r, /Li'(/vw 7� Print Co actor/A nt's ame
Signature of Notary-Stateof -or Date Signa tu tlf9Vt3T _pVli'ticit"k"' Date /40(O
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DA R. CERNO ` Cam"
o W MISSION EXPIRES Eapat► t'nOfI00e s
June 22.2010 ttw p0o>tzs+
O is Contract Mimi or
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APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
UTIL: FD:
ENG
BLDG: