HomeMy WebLinkAbout500 W Airport Blvd (8)-e�`a8.15
CITY OF SANFORD PERMIT APPLICATION �f
Permit #: d rlc;. - 4 � 517 Dale:
Job Address: �Ca� \ A)P SiA- po-y (X--� �l6 �L�l Y�4 l p:�
n � -
Description of Work: L)QL 0.C -\c C7\QSVN &\eI otal Square FFoottage �_ _5 S!60CX)\.�.A
Historic District: K) 0 Zoning: Value of Work: S= ao_py%�
r 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 Nwma R Arldress:1{{�r' C� 1
9� . /-10-1,.# I $ r,:> Phone:
Corr........ �.arrnccM Aod�ress:
aU 1Slz ulr, . Sc��cP r �l_ �c�1-1lD State License Number: r t C, 13oi SIJt�1
Phone & Fax:6S2.: 'F�8S• U-113 I S �1� I Contact Person: V4A PL�LI1-�P11 Phone: LR
Bonding Company: W I f"
Address:
Mortgage Lender: fV 1 lid
Address:
Architect/Engineer:' 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. 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 Aaff-11.
verification that I will notify the own r of the property of the requirements of FI 'da Lien Law, FS 713.
S / gent
nbate Signature of Contractor/Agent te
Pr-in)wner/Agent's a rin Ir for/A t' me
�74 16
Signature of Notary -State of+N rltTa' Date Signature of Notary -State of Florida D to
USA D WITTSTRUCK
EUDA R. CE 0 = Comma DD0449077
M�� �kIY COMMISSION EXPIRES =v &V-�rltivpNsExr r i T1`10/2009June 22 2010 .4254:
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APPROVALS: ZONING: UTIL: FD: ENG: BLDG:
Special Conditions:
Rev 03/2006