HomeMy WebLinkAbout1481 29 StCITY OF SAN'FORD PERMIT APPLICATION
Permit # : ) —X qy (� Date: t I � ly--7
Job Address: 1481 A4"' Sf *-L- - Cn ' b u , 1:7L 3Q 71 3
Description of Work: 4e-y"9d� eek
r—C—�� C .
Historic District: Zoning: Value of Work: S
Permit Type: Building Electrical
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Mechanical Plumbing Fire Sprinkler/Alarm Pool
Addition/Alteration Change of Service Temporary Pole Lam'
— Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair — Residential or Commercial _
Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: ��O e7 " Safi
3 00 — OG 10 — 1 Z"5 19 /� � (Attach Proof of Ownership & Legal Description)
Owners Name & Address: Safi ��or tvf.�+ 4I e- por 4- Ay � or; � I Z dO 4C CJ
G�.ye-knnCA 131146- %Qn'i" d f L=1- Phooe: LJO?
Contractor Name & Address: YYT\A,
State License Number:
Phone & Fax: Contact Person: Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone: _
Address: 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 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 management districts, state agencies, or federal agencies.
Al
AcceDl�nce of pe is verification that I will notify the owner of the property of the requirements of rid�Lien S 713.,\
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1O�Signature of Owner/Agent Date Signa ure of Contractor/AgentDate
SA O Q PI•i t Owner/Agent's Name Print Contractor/Agent's Name
M Si a re of Notary -State of Florida Date Signature of Notary -State of Florida Date
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Z M- m
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DC7 Owner/Agent is personally Known to Me or Contractor/Agent is — Personally Known to Me or
_ Produced ID Produced ID
to v —
1121TION APPROVED BY: Bldg: Zoning: Utilities: FD:
ali (Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions: