HomeMy WebLinkAbout1629 Rinehart RdCITY OF SANFORD PERM I'1' APPLICA'1'tON
Permit # : - Date: q Q
Job Address: I a�( I� I �L� Hti P T 12o r+ Q 5/-) FO21J J Fl-,
Description of Work: _ e L -O C hl l'6l0 OF QAS' djV ='I -c- 5PP_ I o %c,/��L $
Historic District: N l Zoning: Value of Work: $ r 60 o�
Permit "type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Ix Pool
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 11 of Water & Sewer Lines It of Gas Lines
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 Y)
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Parcel #: a L'S - I 1 -,30.- J l Lt- 0000 - Q 0 off. Q (Attach Proof of Ownership & Legal Description)
Owners Name & Address: ice. L.L
1�1� CI�iIFUfNiA Si?o? l�ctvV�Jt_ of G Phone:
Contractor Naure & Address: fi %I }mt-. f)1,11 i \ 1~ 12L 1-/'0
Phone & Fac: _ "T o -j 3 Ll -t" '-t � q Contact Person:
Bonding Company:
Address:
Mortgage Lender:
T, 1 TQC,
State Lice nsy,Number: L1775-2 %/60 0 I I � 99
`V�i L. t , 04n 141111\3 Phone: Fx,� V07
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 tmderstand 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: 1 certify that all of tire foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and Zoning. WARNING; f0 OWNER: YOUR FAILURE TO RECORD A NO'T'ICE OF COMMENCEMENT' MAY RESULT 1N 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 properly 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 1 will notify the owner of the properly of the requirements ofFlo ten aw, PS 713.
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Signature of Owner/Agent Date Signature of Contractor/Agent Date
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Print Owner/Agent's Name Print( nt ac for/Agent's Name
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Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date
Owucr/Agent is _Personally Known to Me or
_ Produced (ll
APPLICAI'ION APPROVED BY: Bldg: Zoning:
(Initis & Date)
Special Conditions:
Con actor/Agent is _ Personally Known to Me or
Produced ID 1%L ht—
(initial & Date)
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