HomeMy WebLinkAbout500 W Airport Blvd (7)CITY OF SANFORD PERMIT APPLICATION
Permit N: ZZ Date: Z
Job Address: (Do k v r'
Description of Work: R���lpun CkX\& Cg]\O—Cf— a5n t, r ,AN& Total Sq re Footage
TIli n
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Historic District: ►�io Zoning: Value of Work: $_ i'q m y
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 'Lone: (FEMA form required)
Owners Name, �&Addyyress: 1"t-tV- L��ppG.0 tl� 1
64/+PCUtNC'4Tlr ?Gail Phone: !` to -%
Contractor Name & Address: '�0.1t1e�Q?�[7�t�e�fr'g `(1C_
d1 1 Le ,,State License Number: C CC I ;'�Q S CQ 9 9
Phone & Fax: S- I Contact Person: Phone. 3S2, 51 �. -0 (e
Bonding Company: �—I P,
Address:
Mortgage Lender: �� I 13
Address:
Architect/Engineer: �� , f� 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 AFFIDAVITA 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 per t s verification tha I will notify the owner of a property of the requirements of F da Lien Law, FS 713.
7/S 0.L o
tgn ure o Owner/Agent Date Si nature of Contrac or/AgentDate
�r
Pr' vomer/Agent'sri tractor gent' Name
ate tgnatp of Nota ate of Florida
EUDA R. C R USA D WITTSTRUCK
MY COMMISSION EY.PIRES i Comma DDO"90�
Juno 22, 2019 = �j� E n s 711WA g
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
UTIL: FD:
Date
ENG: BLDG:
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