HomeMy WebLinkAbout1201 W 12 St/� CITY OF SANFORD PERMIT APPLICATION 7
!rmit # : .S Date:
/
7 �
-b Address: fC.
-scription of Work: J All�f N Total S - are Footage
istoric District: Zoning: Value of Work: S Q
;rmit Type: Building Electrical Mechanical Plumbing Firc Sprinkler/Alarm Pool
ectricaL New Service – # of AMPS Addition/Alteration Change of Service ___ Femporary Pole
echanicat Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
49,
umbing/ New Commercial # of FixturesWater & Se s er,(Li es___ Hof Gas fines
umbing/New Residential: # of Water Closets rLX%Lid I N� Plumbing Repair Lesidential r Commercial ��(1 ' / %v II '
cupancy Type: Resident'al ' ` Commercial Industrial AI' f, A, Al �604,
UP
S&
►nstruction Type:c a # of Stories: # of Dwelling Units: Flood Zone. (FFbi1 form required) 2(
veers Name & Address:
,atractor Name & Address:
one & Fac: 34 c- �✓ / (1 7
nding Company:
!dress:
trtgage Ixnder:
dress:
Phone.
Y L ,
State License(Number : 6
Contact Person:
chitect/Engineer: Photic
dress: Fax
plication is hereby made to obtain a permit to do the work and installations as indicated 1 certify that no work or installation has commenced prior to the
lance 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. 14EATERS, TANKS, and
t CONDITIONERS, etc.
JNER'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
istruction 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 OR 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 die public reaxds of
county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agenci s.
ep[9S.g.
it is verification will the r of a pr 'y of the e ire of F a Lien w
ureof /Agent D e n re of C"ntractodAgent ate
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID
?ROVALS: ZONING: UTIL: FD:
cial Conditions:
03/2006
MY COMMISSION # DD 188491
EXPIRES: February 25, 2007
1-8003NOTABY FL Notary Dm=m Aswe. Co.
Contractor/Agent is Personally Known to Me or
_ Produced ID _ ) e V'b f a W
ENG:
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