HomeMy WebLinkAbout2557 S Palmetto AveCITY OF SANFORD PERMIT APPLICATION
Permit # : u� —a Slq I
Q � Date:
Job Address: 0,sr i s, � Lmevn av �� —44
Description of Work: 1`!�j
Historic District: Zoning:
CLUt l h6 --r Cella I-
Value of Work: $ 4,9' 5V 100
Permit Type: Building Electrical Mechanical ✓ Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS
Mechanical: Residential V"" Non -Residential
Addition/Alteration Change of Service Temporary Pole
Replacement V New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures
# of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential ✓ Commercial
Industrial
Plumbing Repair — Residentialor Commercial
Total Square Footage: ' e)' A
Construction Type:
# of Stories:
# of Dwelling Units:
Flood Zone: (FEMA form required for other than X)
Parcel #: 0 1— ao
OCwnneers NNa`me & Address: �T3n
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0 — 50(0 — 00 00 7
(Attach Proof of O rship & Legal Description)
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4 A LN,1Q k N i%J
_ Phone:
Contract armee &Address: j< O IJ t -0-1L Q
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Phone & Fax: 4 Q -j— 3a --7q 5 S
Bonding Company:
Address:
Mortgage Lender:
Address:
Nt
65
State License Number: �/ t CLQ �Z
-32 outact PerZ
son: D O F -Abe /ill{ 1P phone: ` /� 6 7 - 3,)L
Architect/Engineer: Phone:
Address:
Fax:
Application is hereby made to obtain a pemtit 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 pemuts 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 rec�u'reaae is of Florida Lien Law, FS 713.
1 1 061
Signature of Owner/Agent Date Signature of ontract+Agent 1 Rte
*Sipgnature
FA" � Q
Print Owner/Agent's Name ad-
Name
Signature of Notary -State of Florida Date e of Florida Date
Owner/Agent is _
_ Produced ID
Personally Known to Me or
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
C E, e o
Cmissim Expires Jan 2 , 2011
--Icy-PnEtie--Site-°
Zoning:es:
Conxrssim ADD 5
(Initial & Da "4140% & Date)
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