HomeMy WebLinkAbout1301 E Seminole BlvdCITY OF SANFORD PERMIT APPLICATION
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Permit #: 0 .) / 71, Date:. �[ / d -7
Job Address: i so I . Zeal "!Jo le.) st-v o b,44 F02. 0, ri, 3')'7 -7 1
Description of Work:g14 CL1v 01&-T 4
Historic District: Zoning:
Value of Work: S Li o -D'
Permit Type: Building Electrical Mechanical _� Plumbing Fire Sprinkler/Alarm 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 # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair - Residential or Commercial
1.
Occupancy Type: Residential 't'� Commercial Industrial Total Square Footage: 14 O 37
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA Corm required for other than X)
Parcel #:3t7"'�' 31-- �Q`[ i'�d0 0() 1,0
(Attach Proof of Ownership &Legal Description)
Owners Name & Address: pft V I ID l'c ,� c ArRR eze 1'301 15 . 5,e^ i,Vo I'e a k t/p
AJ -3 -.-7 -7 1 Phone: q07 - q77 4 7 7
Co tractor Name & Address: 1'30 Q FA C �)'Vt.E/ Q �'I G 1F Ate-* l � ^%C
�� o a,0 a State License Number: 121h CD J6-b!7� Z g
Phone &Fax: �/D 7 3zZ-'1YS� 'Y07 -131 -'v3 /— ontact Person: ROD rA C G r� -e4 Phone: 7 407' 33 %— 74'0'.S!�
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer.
Address:
Phone:
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 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 incompliance 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 management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirrmtsof Florida Lien Law, FS 713.
1200 �
Signature of Owner/Agent Date Signature of ontracto Agent Date
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Print Owner/Agent's Name Mtu
PStat,
Signature of Notary -State of Florida Date Florida
Owner/Agent is _ Personally Known to Me or Contractor/Agent is L Personales oym tg,Lvl_
_ Produced ID -
� %No" Public - State of Flotlde
APPLICATION APPROVED BY: Bldg: Zoning: ,, tyommissbn Expires Jan 24, POD 1
(Initial & Date) (Initial &
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Special Conditions:
Date
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