HomeMy WebLinkAbout1748 Travertine Terj CITY OF SANFORD PERMIT APPLICATION
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Application # : Q Submittal Date: CO
Job Address: %! y eR fI ✓q P Value of Work: S
Parcel II): n / Zoning: Historic District:
Description of Work: tJG� �j A-12 f 4 e'eLd-,A&y Square Footage:
..........................................................................................................................
Permit Type: Building ❑ Electrical ❑ Mechanical H Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
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 Water Closets Plumbing Repair — Residential ❑ Commercial ❑
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑ " Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
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PropertyOwner: Ft t RAO C Q 1 _P- 0 •Contractor: t1/' toem '� �� 1�J�C 1 ✓L -
Address: / �� ✓` l (�}CP Address: 0 &y-� /Ul C 45CA.s n/
/�jjTM APIA K.- f - L � oto3
Phone: '•7
qrd ` M%_mail: Phone,7 07 25 5l5 �Mtate License Number: C4CU s� gS
•
Bonding Company: " ` Mortgage Lender:
Address: Address'
Architect/Engineer:
Address:
Plan Review Contact Person:
Phone: Fax:
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 ui me o ri w, FS 713.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
UTIL: FD:
PriQYClyii�p r/ e is N e
Signature of Not -State of Florida Date
DEBB�I t
MY COMM'N 0 pD629096
rY? " '
o�� EXPII2E�: Febr�
�ooa-Noraxv 25, 2011
Fl. NotaryDi Co.
Contractor/Agent is _ Pers
Produced ID
ENG:
BLDG:
Permit # : V T qZ
Job Address: 1"a TrGlyely- -tn�
Description of Work: eY4
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
Date:
) +i'rG Total Square Footage
Value of Work: $ • 7. y b0.`:>"
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 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 Plumbing Repair - Residential or Commercial
Occupancy Type: Residential Commercial Industrial
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
Owners Name & Address:
�r�tcl-t�ield , Ric
i,r1e Tier• �ft�rf�
Contractor Name & Address
Bonding Company:
Address:
Mortgage Lender: _
Address:
Arch itect/Engineer:
Address:
Phone:
U -k- 3a %9 State License N/u�mber: X1w j 352 (
Contact Person: Ck)aJiIICI#-Phone: `iQ -+C6 9305
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: 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 require
rS6-V&;551
3/te/-,
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
APPROVALS: ZONING: UTIL,
Special Conditions:
Rev 03/2006
Date S
Date / S(Rathi[s ivLNota)W.Stile.0i RWNO A I c?r S I Date
FD:
ENG:
BLDG:
04
COMMISSION # DDa27944
r�0it��'A
EXPIRES: July25.2010
(407) 398-0153
Florida
actor gent is
Personally Known to or
Produced ID
ENG:
BLDG:
04