HomeMy WebLinkAbout146 Walnut Crest RunML
e CITY OF SANFORD PERMIT APPLICATION
Permit # : 1 I � v (�D�ate�` — / ��
Job Address: r/ L ' /Z (C_ tktj 01�y1 / uY d FZ 3o-77
Description of Work: �% -u LP 7—AW K. 5 k) D Ps Total Square Footage
Historic District: Zoning: Value of Work: $ 1--0 , 0-0
Permit Type: Building
Electrical
Mechanical Plumbing
Fire Sprinkler/Alarm Pool
Electrical: New Service
— # of AMPS
Addition/Alteration
Change of Service Temporary Pole
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
— Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair — Residential or Commercial _
Occupancy Type: Residential Commercial Industrial
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
Owners Na &Idress:
�` 1JI'
L°nc�6c
GL-li'U,�� f �(,(s1 �-/l � 3 a �� / Phone: a% —Oa 3—dl 9
C n�wractorName&/'Address: j Plw 6'7 V!CeS :Tic �%7 cS • /kfet�✓1'i�%T)`er,103, or& e— M State License umber �i ' OS? 9 ,l/
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
—d 3Qb �� 1 ontactPerson: t C�7� [7�12Z/ Phone: 3dto %Y 7'7� l 9
Phone:
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: 1 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.
Acceptance of permit is verification that I will notify the owner of the property of the
Signature of Owner/Agent
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is _
_
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
Personally Known to Me or
UTIL: FD:
airement of lorida Lien w, FS 713. /
77
gna� re of Con .ractor - gent Date
_Ir�t,�rtil
Print Cont— ent's Name
ChAA IdXaAAO�-- -2� 10pbn
Signature of Notary -State of Florida Date
Contractor/Agent is X Personally Known to Me or
Produced ID 9 l 107
6
ENG: BLDG
CHRISTINA DECARDENAS
Notary Pubk - SW* d FW4a
3w1y Cortunisahxt E><Dlras Sep 2S, 2010
'-s F Commbslon 0 DD 508616
a�-�:"I...0- By Mad" N=
0
PERMIT
AUTHORIZATION
I Vincent Polizzi_hereby authorize
License Holder)
/ to obtain a gas plumbing permit
(Auth rized Person)
in y behalf under my license # CFC057948
for the job described below
DESCRIPTION
Owner
Site Address
T
State of Florida
County of VVO I��
Affirmed and subscribed before me this day of 4LAV 201 byyC���b� (J—D
Who is ersonall known o me or has produced (type of ID) as identification
Signature of Notary Public, State of Florida Print, Type or Stamp Name of Notary
0�1-11111ST DECARDENAS
, i;!. Notary Public
Shft of Fbfida
Notaries Seal �ExpkesSep25 2010
4t :� Bonded By Mand Notary Assn.
001:... 11: 27 AM Florida Public Utilities
.41
w
T C -k'—' Tnra Kl ess
?'fuo,j' Awtc- Q t m
tiaq, (ti. 1
N 076
_4 �—=
C Gn�aGE
A41
J wy�w
ry
No, 4936—P. 2/2
5
�mocGe 10 e&'
a 5+CkA
g,ej I• n 2 4v ro-n
C,�4i ol-) r--e,I lin Z
- v,-�u r e. 3( i 11 1 o ca -k o n
6f) si au o4 0u s e.
I InS+urQ� blue C -a -f
wosed
so4c- h
dAo7)b-�
�,vA��iur
CKC-sT �uN
KLAN REVIEWED -
r j.
Emm 67
CITY OF SANF RD
r
hotiSe- A4
t J
S i