HomeMy WebLinkAbout1401 Semmole BlvdCITY OF SANFORD PERMIT APPLICATION
Application # : i�l � —at/ Submittal Date: T
Job Address: -A S Z/ f/rt f).QQ a L Lb Value of Work: $, f
SO -o
Parcel ID: i?$ ; % 30 • $,4&•-o/17 om /7/T Zoning: Historic District:
Description of Work: A& ,'� )tU66 l O / quare Footage:
.............................................................................4..........................................
Permit Type: Building ❑ ElectricalX Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service - # of AMPS fln
// J' Addition/Alteration 13 Change of Service 13 Temporary Pole ❑
Mechanical: Residential 13Non-Resid@ntial ❑ 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 ❑ Commercial ❑
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
...........................................•......................................... 0........................ .......
Property Owner: (. Contractor: % ' } U'clj
Address: PT T" 115D Address:
Ata�� 7A), 3727 D �-
Phone-3?I Zffg S� 7 E-mail: �� j,Ak liione: Z - State License Number: S13
Bonding Company: Mortgage Lender:
Address: Address:
Arch itect/Engineer:
Address
Phone:
Fax:
Plan Review Contact Person: Z Phone:,s'z�7Fax:2��a7y/n�/ E-mail:�
7
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 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 governmental entities such as water manage r�r ent districts, state agencies, or federal agencies.
Acceptance of permit is verificatV9(ffip I will notify the owner of the property of the
Date
Pri O4er/Agent's Name
._sem14 9- a-)-
5ienatur of Notary -State of Florida Date
own Stephanie Netzer
= my Commission DD369329
Owner/�S`s�va�n nr
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
UTIL: FD:
lire ms of Florida 1 aw, FS 713.
gnat re t Vr/Agent Date
_ %L LIZ
�rin ontr for/Agent's Name
Signature o Notary -State of Florida Date
Dov pu Stephanie Netzer
my Commission DD369329
G p
Expires November -0-4,, 2-0-0-88
Contractor/Agent is LPersonally Known to Me or
Produced ID _
ENG: BLDG: