HomeMy WebLinkAbout1407 S Park AveCITY OF SANFORD PERMIT APPLICATION
Application #: Q -7" ` 1
Job Address: S PAfK< SAN .
Parcel ID' Zoning:
Description of Work:
ibmittal Date: c��`f
Value of Work: $ / )• CV
Historic District:
Square Footage:
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Permit Type: Building ❑ Electrical ❑ Mechanical 6d" Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
' Mechanical: Residential ❑ Non -Residential ❑ Replacement d 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 Ed' Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
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Property Owner: J f`` Q"J / M -2r �S �� Contractor: ye �i pt r�" L:
Address: I Li n 1 .J. 'W" K Au 2 Address: Zyec, /w
Chi/Y9
Phone:yd7 '70y E-mail: Phone.i 7 �� State License Number.
Bonding Company: Mortgage Lender: '
Address: Address:
Architect/Engineer: Phone:
Address: Fax:
Plan Review Contact Person: Phone: Fax: E-mail:
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 manement districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the require nts of I l Lie w, FS 713.
Signature of Owner/Agent Date ignatur of Contractor/Agent Date
f(.,I M05M xz
Print Owner/Agent's Name t Contractor/Agent'sTame
JJC� 4 b `i
Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
UTIL: FD:
Contractor/Agent is Personally Known to Me or
_
Produced ID p
ENG: BLDG:
A_�S-3�06