HomeMy WebLinkAbout1109 W 10 St (2)7 �j (� CITY OF SANFORD PERMIT APPLICATION
`J 'S, l / Date:`
,b Address: /-/07 W_ • ` �� 5r
!scription of Work:
//U�/ C7 `� /�A.
�4- C/ /�
er i js� Total Square
istoric District:
Zoning:
,Footage
Value of Work: S 2- r ryp 6
-mit Type: Building Electrical _ Mechanical _ Plumbing Firc Sprinkler/Alarm Pool
ectricaL New Service - # of AMPS Additiorr/Alteration Change of Service _ Temporary Pole
echanicaL Residential _)C_ Non -Residential Replacement .1k, New (Duct Layout & Energy Calc. Required)
umbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
umbing/IYew Residential: # of Water Closets Plumbing Repair - Residential or Commercial
:cupancy Type: Residential _y_ Commercial Industrial
instruction Type: It of Stories: At of Dwelling Units: Flood Zone (FEMA form required )
veers Name & Address:
2! 741.0
,atractor Name & Address -
191, -Ale le n• .�,/J C 11
0 7-
State License Number:
one & Fac Contact Person:
ading Company:
1dress:
trtgage Lender:
dress:
chitect/Eagineer Phone.
dress: fax
plication is hereby made to obtain a permit to do the work and installations as indicated 1 certify that no sock or installation has commenced prior to tine
ianee 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
mit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
2 CONDITIONERS, etc.
dNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and drat all work will be done in compliance with all applicable laws regulating
tstruction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
+ICE FOR IMPROVEMENTS TO YOUR PROPERTY_ IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER Olt AN
TORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT_
NICE: 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
county, and there may be additional permits required from other governmental entities s ch as water management districts, state agencies, or federal agencies.
xptance of permit is verification that 1 will notify the owner of the property of the r e is of Florida Lien Law, FS 713.
t.
Signature of Owner/Agent Date ere of Contractor Date
Print Owner/Agent's Name Print ontractor gent's Name
Signature of Notary -State of Florida Date Signature of Notary -.'tate of Florida Date
DEBBIE BLANTON
My CoMmISSION # DD 188491
EXPpIRES: February 25, 2007
Owner/Agent is _ Personally Known to Me or Contractor/Agen is " cc nally ngQ,v o
Produced ID Produced I t_'e IT .ar
'ROVALS: ZONING: UTIL: FD:
cial Conditions:
03!2006
ENG:
BLIXi: