HomeMy WebLinkAbout170 Red Cleveland BlvdCITY OF OF SANFORD PERMIT APPLICATION
Application # : D 1 a L' 9 � Submittal Date:
Job Address:
-70 Re le
6 C ve I Gn d aVd. %C'15M Cr Value of Work: $ ""0 y
Parcel ID:
Zoning:
Historic District:
Description of Work: f- kc c- 'TTL Nw__ k -r AR, 5 L ru 1 C i°Square Footage:
Permit Type: Building ❑ Electrical Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service - # of AMPS 3LIAm addition/Alteration 10' 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 Water Closets
Occupancy Type: Residential ❑ Commercial ❑
Industrial ❑
Construction Type: # of Stories: # of Dwelling Units:
Plumbing Repair —Residential ❑ Commercial ❑
Occupancy Use Group(s):
Flood Zone: (FEMA form required)
................................................................................................................
Property Owner: San �bc ct I'i (- GZx V Av+h«- Contractor: .>0A Zr CA %i r pnr �-
Address: 12 oU Pyr_6 cAe.Ye. an CJ Siy Cl• Address: IZ_ 0U ELea CIGYe �C3n Q (YC .
SOn SDA , FC 3a-77 3 Son4,ci . EL 3Z 7 - 3
kou o-1 58 �. �,l
Phone: �8J— NULO E-mail: Phone: 000 State License Number:
Bonding Company: )J I A- Mortgage Lender: <.) /14
Address: Address
Architect/Engineer: til / 14- 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 management districts, state agencies, or federal agencies.
Acceptance of permit verification thaLLwilIzutfthe owner of the property of the requirements lori w FS 713. -
-/S =
Signat re of Owner/Agent Date Signature of Contractor/Agent b Date
Printer/A e is arae Pri tr to A is Name
Signature of Notary -State of Florida Date Signature of otary-State of Florida bate
"lPPHYLLIS
F
L GIBSON
MY COMMISSION #DDA�75#004775L,`.
EXPIRES: OCT 02, 2009
Owner/Agent is _ Person��
�DH66``Plih�bL�sRrState Irisuranc:
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
UTIL: FD:
PHYLLIS I. GIBSON
MY COMMISSION #DD477598
EXPIRES: OCT 02, 2009
Contractor/Agent is ondI MdNiliffugh 1st State Insurance
_ Produced ID
ENG: BLDG: C77