HomeMy WebLinkAbout107 W 9 St (2)-7 CITY OF SANFORD PERMIT APPLICATION
Permit # :. 0 / —/S/ � Date: _
Job Address: _ l O-7 _ q-L'O-. 6r -
Description
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Description of Work-
Historic
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Historic District:
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Zoning: Value of Work $���
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS Addition/Atteration ACAR Change of ServiceTemporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cale. Required)
PlumbiuW New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Pltunbing/New Residential: # of Water Closets Plumbing Repair - Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stoles: # of Dwelling Unita: Flood ?one (FEMA form required for other than X)
41111301
Pared #: 7-6 — L7
Owners Name & Address:
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Contractor Name & Address:' Z'
Phone & Fa:: W7 94N 14I 1Y° 7
10q —oo/ 6 (Attach Proof of Ownership& Legal Description)
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=(� PState License Number: ( "C..�30
Contact Person: _cfi(�N f-/ /tPhone:
Bonding Company: t"l'k
Address:
Mortgage Lender: -
Address:
Archited/Engineer: Phone:
Address:
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Application is hereby made to obtain a permit to do the work and installations as indicated I certify "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
pemut 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 govemmerdai entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit is veriffeation that I will notify the owner of the property of the requirements of Florida LwY 71
31"
Signature of Owner/Agent Date Signature of Coatrador/Agee . Date
Print Owner/Agent'sNamme OHA tradSm/A t'eNAte! T �Lf /�� Sf%(i10E
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Signature of Notary -State of Florida Date Sighabare of Notary -State of Florida — Date
PAMELA BIKOWICZ
Notary Public, State of Florida
Owner/Agent is Personally Known to Me or Contractor/Agent is ✓Cuy Kn t0NWy c o m r i . n p . Sept. 3, 2007
Produced ID —Produced ID CVn:-14 ?:;a DD 246932
3- ►3 -0?
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
(Initial kJostro (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions: