HomeMy WebLinkAbout1903 S Palmetto Ave (2)CITY OF SANFORD PERMIT APPLICATION
Permit #: 0-7--.1 40 Date: 3 1 7
Job Address: 19 6 '23 oU e—
Description of Work: 5C!K awe UQ i4Dr �e 200 o*yogS eC.&,ygr ; �jj// _/ 9
Historic District: Zoning: Value of Work: $191,2_0,600
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS 200 Addition/Alteration ke"4 Change of Service I""'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 Total Square Footage:
Construction Type: &a Ce # of stories:1_ # of Dwelling Units: �_ Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Contractor `lame & Address:
(Attach Proof of Ownership & Legal Description)
Phone:
7—
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f'igrK Dy" XMWd!5 rp 0' 1( 31013 St a a License ;Number: 16;c 1260194-3
?hone Lic Fax: !Q1% -3-i.Z^ is 6-L.• Contact Person: �y K!!;fThane: #61-9 U O S
O
3onding Company:
Address:
Mortgage Lender:
address:
:.t o the ;n .aaaLIO:
:55llance �,; erm...ond mat a", „ rh iii „e pe; ormed ._., meet standards c, _il laws `onsrruc,:on in :ais iunsaicnor,.
Deur it mus_ ae secured "or i:LEC-RICAL VOR:K. rLUlAl3fN'G::IGNS,V? LLS, ?OOHS, r uRNAC2S, 301LL•RS. EATERS. -ANKS. and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify that all ofthe 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 PAYIZtg
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 requireme is of Florida Lien Law, FS 3.
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Signature of Owner/Agent Date S' Lure of Contractor/Agent Date
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Print Owner/Agent's Name Pri ontractor/Agent's N
3`vr l�
Signature of Notary -State of Florida Date Signature ofNoEaiy-9fiite of Florida Date
Owner/Agent is _
Produced ID.
Personally Known to Me or
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Contractor/Agent is _ P' rsonally Known to Me or
Produced ID
Zoning: I
Utilities:
(Initial & Date) '
(Initial & Date)
FD:
(1ll1t161 OL L6LGJ