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CITY OF SANFORD PERivIrr APf LI!CATION
i
Date:
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Job Address:
Description of Work:
Historic District:
Permit Type: Building Electrical Mechanical Plumbin _ Firc Sprinkle Alarm x Pool
Electrical: New Service —# of AMPS Addition/Alteration , Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New(Duct Layout & 1 nergy Cale. Required)
Pl nibing ew Co ininercial: # of Fixtures '• # of Water & Sewer Lines # of Lias Lines
tial: # of Water Closets Plumbing Repair — Residential or Connncrcial
Occupancy Type: Residential Commercial rtdustrial Total Square Footage:
2,8 zoo?
Construction Type: 0_00P # of Stories: i # of Dwelling Units: ' Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address: I I 1 7• K_ F_ I a`
(Attach Proof of Ownership & Legal Description)
E�e-K UR I Si t-,jr6 D FL -,5Z77(
tw �/ l'huue:
Contractor Name & Address: DF•►^TP+ ��•�`� �r n F °L�' ��
1 t' z' CS-p'N rogy> -�St�a+te LicenseNumber: 11 ^� y
Phone & Fa,: 40-7 "''I 7-f- •3,000 i 40 "�2$^ Contact Person: A AGK ` •-+p���'�`�` Phone: 40 ` ` •�Z$^
Bonding Conti
Address:
Mortgage Lender: —- -
Address: -
I'hune:
Address:
Application is hereby made to obtain a permit to do the work and installations as in dreafedc-Lcertify that no work or installation has corrunenced prior to the
issuance ora permit and that all wort: will be performed to meet standards of alt laws regulatingcufistruu��lion in this jurisdiction. I understand that a separate
permS BoLit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACE_RS, IIEATEKS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify that all or 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, CONSULTWITII YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT,
NOTICE: In addition to the regr'rements i f this permit, there may be additional restrictions applicable to this property that may be found in the public records or
this county, and there may be a, ditior al per lits required from other governmental entities such as water mauagcment dLaacts tate agencies, or taderul agencies.
Acceptance of permit is veritic dt 10 hWlotifyownet' of the property of the t'equirvmettts uI'Florida Lie inv, FS -J2-Zg.a7 / Signature of Owner/AgentDate Signature of Contractor/Agent Uate
-[A2L�51,1 �10NTC�OYh�R `( _ l' Flet-�S G� . Yhp� Com r��Y
Print Owner/Age Print Contractor/A' is Ntuue ��77
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Signature of Notary -s3
5a�__ of Flo�n Signature of Noht - 'tate urflorin Date
Jacob L-OCky6r
• tNy Cammiasion DD335499 J4cob LAW • My Cornmisolon DD336490
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• J6fji07 2008is�joly 2W8
)wn gent is _ 'rsonally Priown to Mu or on r icto • gent is _ Pe sonatl�'1�'ltowt
_Produced ID cod IU
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APPLICATION APPROVED BY: Bldg Zoning: Utilities: I D.
(initial SE Date) (Initial &Date) (Initial &Date) (Initial &Date
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Special Conditions: `-1(7
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