HomeMy WebLinkAbout542 Plumosa DrI CITY OF SANFORD PERMIT APPLICATION &,-.2G
Permit #: Iy) `/ Date: to - .2 G - U (P
Job Address: -014
Description of Work: Se 4 -
Historic District:
0-170 'rC"L,
2xi 5•t7' ' � .[
Permit Type: Building Electrical Mechanical Plumbing t/ Fire Sprinkler/Alarm Pool
i
Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
I
Plumbing/New Residential: # of Water Closets Plumbing Repair- Residential or Commercial
Occupancy Type: Residential ✓ Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 7 I — I —1 —
Owners Nam1 &'Address:
t -� d -3.;L
Contractor Name & Address:
CMING--TAra
10
(Attach Proof of Ownership Legal Description)
Phone:: 10 7 -/ 3 a !-f - 55
15-6-r-rled - . (r
�y State License Number: L- r6- 01 (0 1
Phone&Fax: a -?q-11610 ContaclPerson: ou)C lI Phone: A107-.2i3-&&qLf
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: 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, c1c.
OWNER'S AFFIDAVIT: 1 certify that all of the foregoing information is accurale 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 is verification that I will notify the owner of the property of the requirements oViorida Lien Law, FS 713. +/
! ,6,6, 6 TJO
Signature of Owner/Agent Date Signnnature of Contractor/Agent Dale
�,6'-,r-7 s, el' Q P" in
Print Owner/Agent's Name Ynnl Contractor/AWnl's Name
Signature of Notary -State of Florida Date Signature of Notary -Stale o ' a
DEB81 ,
S � ry26,20
�pMtA1S o0
NN tRFsS:Feb� �.Go•
Owner/Agent is _ Personally Known to Me or Contractor/Agen is on KppsWphb
Produced ID Produced I ANON
APPLICATION APPROVED BY: Bldg:
(Initial & Dale)
Special Conditions:
Zoning:
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)
�a�
L