HomeMy WebLinkAbout1201 WP Ball BlvdPermit #: y
.lob Address:
Description of Work:
Historic District:
CITY OF SANFORI) PERMIT APPLICATION i
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Date: �/�il/
��7 �t� H �00?
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Total Square Foo
Zoning: Y Vat
uc of Work: $ `Y) QUOL
Permit Type: Building---- Electrical Mechanical Plumbing , Fire Sprinkler lartn Pool
Electrical: New Service – # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New —_ (Duct Layout & Energy Cala Required)
Plumbing/ New Commercial: # of Fixtures 11 of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair -- Residential or Commercial
Occupancy Type. Residential ---- Commercial Industrial
Construction Type: # of Stories: It qt' Dwelling Units: Flood Zone: (FEMA form required)
Owners Name & Address:
Contractor Name & Address:
Phone & Fos:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engincer
Address:
Phone:
State License Number:
Person:
Phone:
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 perfortnui to me;t standards of all laws regulaiing construction in this jurisdiction. 1 understand that a separate
pennit must be secured for ELECTRICAL WORK, PLUMBING, SIUNS, 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 FA[LURE TO RECON A NOTICE OF COMMENCEMENT MAY RESULT 1N YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY, IF YOU INTEND TO OBTAIN FINANCING, CONSULTWITH 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 tray be additional permits required from other governmental entities such as water management districts, stale agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requil« alts ort a)Lien Law, FS 713.
Signature of Owner/Agent Date
Print Owner/Agent's Nanie
Signature of Notary -State of Florida Date
Owner/Agent is ._ Personally Known to Me or
Produced ID
APPROVALS: ZONING: UT'IL: FD:
Special Conditions:
Rev 03/2006
?-/c-.,>'7
o )Contractor/Agent
Signature of Notary -State of Florida Date
CHRIS M. CHASSE
Notary Public, State of Florida
My Comm. Expires Feb. 18, 2007
Contractor/Agent is —y-1— Personally Kuowu to N or No. 00184911
Produced 1D
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