HomeMy WebLinkAbout204 S Bristol CirPermit #
Job Address:
67-�6-3 r- Mra- - (37/20
CITY OF SANFORD PERMIT APPLICATION
Description of Work:
Historic District:
Permit Type: Building Electrical
Electrical: New Service # of AMPS
Mechanical: Residential Non -Residential _
Plumbing/ New Comme ficial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
Mechanical Plumbing 14— Fire Sprinkler/Alarm Pool ,
_ Addition/Alteration `Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. Required)
_ # of Water & Sewer Lines # of Gas Lines
Plumbing Repair <Residents Commercial
Industrial Total Square Footage:
_ # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: / - & . w� � / /v
— // (Attach Proof of Ownership & Legal Description)
Owners Name & Address: [CDS
t Phone:
Contract r Name & Address:
AWState License Number. � G
Phone & Fax: Contact Person: Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
Application is hereby made tolobtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to ihr
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 regulai.iog
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULO. IN YOUR PAt ICKi
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 manage ent dis ' ts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of P� Li �-
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg:
Special Conditions:
Signature of CXntractorX26nt Date
Print C0-nt1pAtQr/Affnt's Name
Signature of Notary -State of Florida Date
Contractor/Agent is _ Petsga fi ow BL A1VT�I�1`
" 4 ' fSISSION # DD629096
_Produced [DIRi?3 February 25, 2011
I:Nf#VAOTARY Fl. Notary Discount Assoc. Co.
Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (initial & Date) (Initial & Date)