HomeMy WebLinkAbout1413 W 15 StCITY OF SANFORD PERMIT APPLICATION
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Permit #: V Date:
Job Address: 3 (t_i /
Description of Work:
Historic District: Zoning: Value of Work:
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Permit Type: Building t/ 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,Wateer sets Plumbing Repair— Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage: d 40 4
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address:
.-3)? rG— ) Phone:
C tractor Name & Ad cess:8 (
State License Number.
Phone & Fax: Contact Person: Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
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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 m7ulating
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 OF A.N
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 jouRiy�ients of /62da U4,4;13.
Signature of Owner/Agent
Print Owner/Agent's Name
Signature of Notary -State of Florida
Owner/Agent is _;Personally Known to Me or
_ Produced ID
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Date
of
Name
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Date
Date Aignature of Notary -State
MY COMMISSION # DD629096
CW EXPIRES: February 25, 2011
Contractor/Agent is _ wnq%0NgkFjascamtAssoc. Co. R
Produced ID
Zoning: Utilities:
(initial & Date)
FD:
(Initial & Date) (Initial & Date)
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