HomeMy WebLinkAbout500 W Airport Blvd (6)CITY OF SANFORD PERMIT APPLICATION
Permit #: (v Z� `' G � 7 Date:
Job Address: IQ CX> rtt
Description of Work: R P T\-\nL)e_ \,\ CP O�Q ( rte a Total uar_e Footage �Z_
Historic District: �) O Zoning: Value of Work: $ I�'�
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
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:
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:_ N" v la -k— v& LLC UIR-R \% i A -D ,
'lk,t 7e0S Phone: 8/ %— S� d 7 7/ L
Contractor Name & Address:
QLkkkg S`e _ UQ 0, (x n'0 �`- ?�'l�Le State License Number:
Phone &Fax:.3S2-3165•yZ$3 .31aS-91 Contact Person: A'\ Rte" Phone:y3SZ-Sltrz-O?�Ce
Bonding Company: N1 Pr
Address:
Mortgage Lender:
Address:
Architect/Eagineer: N 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: 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 m be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of peri ' ver* ati t I 1 notify the owner of th property of the requirements of Florida Lien Law, FS 713.
nature O er/A nt Dategnature of Contractor/Agent Date
c r, / �t� r r 07. ,, _
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
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J (//k;
-71 Pnjgrlontractor/Aget' Name
,s/o& /"/III 4
EUDA R. CERNO
MY COMMISSION EXPIRES
lune 22, 2010
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UTIL: FD:
D WITTSTRUCK
COMM DD0449077
Expin s 7/10/2009
Banded thru (600)4324254'
ENG: BLDG:
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