HomeMy WebLinkAbout2200 S French Ave\ CITY OF SANFORD PERMIT APPLICATION
Application # : r7' 1 C�. -i � j Submittal Date:
Job Address: �—"�� �,�� A t/P Value of Work: $ i000 02
Parcel ID:
Zoning:
Historic District:
Description of Work: p� pr I sip ^J t [ Q Z— Z C141(_ Square Footage:
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Permit Type: Building ❑ Electrical 61"' Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pooh ❑ 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 ❑ Commercialli Industrial ❑ Occupancy Use Group(s):
Construction Type: # of Stories: _t_ # of Dwelling Units: Flood Zone: (FEMA form required)
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Property Owner. /�JL r ` �n ,v nI ®,'J Contractor. // $o v3 S Ant J)6?t5 Z-7 G -
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Address: Address -..`7 D,� c.014
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Phone: E-mail: Phone: 't0 '1tiUs�o1� State License Number. Lr' C 0 00/ 5—Y
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 CONRAENCEMENT 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 publicrecords of
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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 offFFlloridaLien Law, FS 7I3.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
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PrintOwner/Agent's Name t Co frac t's Name
Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date
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MY COMMISSION # DD629096
Owner/Agent is _ Personally Known to Me or Contractor/o�I�t�ie
Produced IDProdu-NorARv FI. Notary Discount Assoc. Co.
APPROVALS: ZONING:. UTIL: FD: ENG: BLDG:
Special Conditions:
Rev 02/2007
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