HomeMy WebLinkAbout105 W 30 St (2)(
CITY OF SANFORD PERMIT APPLICATION
Application # : 01" I f -s Submittal Date: 3130 /C)7
Job Address: I05 KI 30-rW cam.' cS,4*JC6 _b . �. 3 773 Value of Work: $ 38 Oo
Parcel ID: 01 o20- 30 - 5/8 - DOO 0 — 0 a-50 Zoning: / Historic District:
Description of Work: S-�54"a l�j/1Q dl/pyl /f 4a��/1��11SC/ f 3 sSquare Footage:
........................................................................................................................
Permit Type: Building ❑ Electrical ❑ Mechanical V Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS Addition/Alteration V Change of Service ❑ Temporary Pole ❑
Mechanical: Residential l' Non -Residential ❑ Replacement ❑ New ❑ (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑
Plumbing Repair —Residential ❑ Commercial ❑
Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
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PropertyOwner: (& y A/E AesA goin Contractor: • �r%�// S
Address: 16)5 3.0.0-A ST. Yd Address: Ronald gcqq�n Rd
ro q!1(G6r20 GL. 3-77 1 ,L.Lom&joo 3a7.sv
Phone: 7 •0?%01 E-mail: Phone: 4b% 8'36- % S State License Number: eMe10;l f9V0Ci
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Lender:
Address:
Phone:
Fax:
Phone: Fax:
E-mail:
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 in nagement districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of F ri a Lien Law, FS 713.
i` LOf �3 30 07 3 b30/01
7�1Signatu f Owner/Agent Date Signature ontractor/Agent Date
�yz/1tJN, C �O 13vP-0Dennis !3' rower
Print Owner/Agent's Name �Print Contractor/Agent's Name
-41300-1 r (12 (::� 330 0 ?
Signature of Notary-Stio of Florida _ Date Signature of Notary -St e of Florida Date
L��OF
Notary public State of Florida � y pV Nrflery Pu aState of Florida
Nortel Cruz �Novel Cruz
My Commission DD616976o-�My Commission DD616976
Ex ires 11 /26/2010 �'� of r�° Expires 11126/2010
Owner/Agent is Personally Known to Me or Contractor/Agent is r Personally own o e
Produced ID Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
UTIL: FD:
ENG: BLDG:
$S3,06
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