HomeMy WebLinkAbout2415 S Elm AveCITY OF SANFORD PERMIT APPLICATION
Permit # : D �— Date: y1-30,12,00 7
Job Address: aig15 5, F (— M .pAve
Description of Work: Q,v-t� @x.Y' CI .IJP i 1X 0_"
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Historic District: Zoning: Value of Work: $ 4 (o45' 00 R. _..-
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool _
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential VI -1" 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 L--- Commercial Industrial Total Square Footage: 1 del q
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required: Ear ar@Ir.ee ti zhT. X)
Parcel #: .1(p -� 9 — V — 3 S — 0000 " O O S'O (Attach Proof of Ownership & Legal Description)
Owners Name & Address: -IAtM e S r i Ar ch _
Contractor Name & Address: RoO FQ e �e .-, . �- A A k i�0 S �• 1 �► S �� 41z1
SR-►JFOAp 1PI, 3x-77
Phone&Fax: VQ 7— 37A-7ct55—
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
State License Number: VrJ LV Z>y y L b-
Person: Roo FAee-n jet Phone:
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 late regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PA'YI:NG
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 requireent of Flo da Li Law, FS 713.
2oa 7
Signature of Owner/Agent Date Signature of Co tact /Age t Da
2ODAM FA -C -C e2
Print Owner/Agent's NamePri o tra r/ e Na
`� 30 �o01
Signature of Notary -State of Florida Date jgnjkur of -State of Florida Dfate
Owner/Agent is -
_ Produced ID
Personally Known to Me or
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Zoning:
(Initial & Date)
Commission Expires Jan 24, 2011
Commission # DD,309055