HomeMy WebLinkAbout2650 S Myrtle Ave��sgt1 �� 'rim .
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CITY OF SANFORD PERMIT APPLICATION
Application # : 0� Submittal Date: (1 rt , )-) C)
Job Address: �oSCi S . �► t� Value of Work: S�
Parcel ED:
Zoning:
Historic District:
Description of Work: 1R2— V_o o r Loose_ Square Footage:
.........................................................................................................................
Permit Type: Building 11 --Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ 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 Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: # of Stories: 1 # of Dwelling Units: 1 Flood Zone: (FEMA form required)
...........................:............................... ........................................................
Property Owner: I (a A� Contractor:.
Address:\ ddress: Zoo
Phone:L4 - � 1`7ME-mail: e-661`(0 E-mail: State License Number:
Bonding Company:. _:_ ., Mortgage Lender:.... ...,
Address:.
Architect/Engineer:
Address:
Plan Review Contact Person:
Address: .
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 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 a licable to this property that may be found in the public records of
this county, and there may be additional permits required from other govve mental such as water manageme districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the prope a require of -Flo i FS 713.
d �GI d
ignature of Owner/Agent to Signature of n for/Agent Date
P ' t Owner/Agen ' ame Print on actor/ is Name
ate SidhIture of Notary -State of Florida Date
MAXINQ TRAPHA09N
Notary Public, state of Florida
COMMISSION DD803%8
My 00mm. expires Oct. 23, 2010
Ozone gent is Persona no o _ or Contracto"t_Y r
roduced ID ->°��� _ Prod
FIRES: February 25.2011
APPROVALS: ZONING: UTIL: FD: _8w- v FI. Notary Dis tAs
Special Conditions:
Rev 02/2007