HomeMy WebLinkAbout1301 E Seminole Blvd (2)Permit #
Job Address:
Description of Work: _ / y
CITY OF SANFORD PERMIT APPLICATION
Date: % en 7
Historic District: Zoning: Value of Work: S Lv�3.B0o
Permit Type: Building Electrical_� ?viechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service – # of AMPS !qW— Addition/Alteration v' *4 Change of Service Temporary Pole /Yo
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
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: &6 # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: [)AjfA &Ltee Cf-Y-ere_y4A
�52¢D RC R ;� wi v�l/� f ///1995 f L Phone:
Contractor -Name & ;address: �/�%//►V/�dl � L�L6CT" C� /�iVL S ZZ /�/9✓/% ��Q
S�i/V�D✓� L 32'/ 1 State License :Number: 4-C /3Q0190
?hone _c ax: p�- '� ��Z` �� Contact Person: 3=�7f Y N _?hone: 92D -4 GO 5
3onding Company:
address
_` lortgage Leader: _
address:
leer: _ ---- - -- hone:
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ssuane c. .rm::. nd ,nat ..t; .: rh ui '':.;e per_omea .::acct standards c - ii laws Lw,azin'z construe .on in :,.is , isaic:: on.
aermit mus: ce secured for ELECTRICAL WORK. _=LUiAB1NG, SIGNS, YELLS. POOLS. ; uR ?Acca, 301-cRS. E.y, RS. -,ANKS. ana-
AIR CONDITIONERS, dtc.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with ail applicable laws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYIh,g
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 requir a is of Florida Lien L w, FS 71
Signature of Owner/Agent Date Si tore of Contractor/Agent Date
Print Owner/Agent's Name Print C ctor/Age is ame T nk
ori
Signature of Notary -State of Florida Date ignature of Notary -State of Florida Commission #DD369931 i
aQ Expires: Sep 08, 2008
Bonded Tlnu
r / " Atlantic Bonding Co., Inc.
Owner/Agent is — Personally Known to Me or Contractor/Agent is v Personally Known to Me or
Produced ID Produced ID
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions: