HomeMy WebLinkAbout171 Red Cleveland BlvdCITY OF SANFORD PERMIT APPLICATION
Application #: Q a 15- n Submittal Date:
Job Address: 1 `1 i PICC) C t C VC_ � O n a G IVC1. Sem TDA CA Value of Work: $ SO
Parcel ID:
Zoning:
Historic District:
Description of Work: e k<.CG•4X L t(yXa er U I Ce frttf'1"IC St4 I Square Footage:
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Permit Type: Building ❑ Electrical Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service - # of AMPS c P r& -V Addition/Alteration 4( 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
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑
# of Gas Lines
Plumbing Repair - Residential ❑ Commercial ❑
Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
.........................................................................`..��1a-Cj Dc�r J•
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Property Owner: JQn yorcl 4 i r por �ua-i'1c�r t Contractor: �C..i��JA e- fav �-I�►ori_ .
Address: Moo Qed e,levelonel 61VeL Address: IZ00 Red clave -kind 131Y
So J I B, .39.773 �n�xCl, PC 9
37773
y07 &(&,)
Phone: s$�' qor� E-mail: Phone: 589� -t-1 b[x) State License Number:
Bonding Company: I) (4 Mortgage Lender: N ! %�—
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Address:
Phone: ''ax:
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 is verification that I will notify the owner of the property of the requirements o d�Lien Law
Si ature of Owner/Agent Date Sign e of Contractor/Agent Date
2 C a -/s =a7
Print 0 r/A ent's Name
r a7
Signature of otary-State of Florida Date
rarip PHYLLIS I. GIBSON
4'n MY COMMISSION #DD477598
EXPIRES: OCT 02, 2009
Owner/Agent is _!� Yerso� 1 , , , vRAad%h 1St State Insurance
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
UTIL: FD:
tj( kmk �I /s=07
Print^r tc /A ent's Name
67
Signature ofA otary-State of Florida Date
fi + Ati^0.Y.P PHYLLIS I. GIBBON
z° B4 -,N MY COMMISSION #DD477598
EXPIRES: OCT 02, 2009
Contractor/Age/Personally is Personally Knowrt r Bonded through 1st State Insurance
Produced ID
ENG: BLDG:.