HomeMy WebLinkAbout2741 Beardall Aver� CITY OF SANFORD PERMIT APPLICATION �� /
Application #: It LQ �` Submittal Date: 67
Job Address: ar7 Li- rr,,�� i '! (2n_rd_aJ^ ( 7 � it , p Value of Work: $ �66
Parcel ID: - D_3 — 5A Y— " I'f AD Zoning: Ill — Historic District:
Description of Work:
Square Footage:
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Permit Type: Building ❑ Electrical Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS 4 Addition/Alteration ❑ Change of Service ❑ emporary Pole `
Mechanical: Residential ❑ Non -Residential ❑ Replacement ❑ New ❑ (Duct Layout & Energy Calc. e
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: # of Dwelling Units: Flood Zone: (FEMA form required)
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CC,^, ..__ fo�1 A l f of+ hof d k
Property Owner: �` p_ /�,_• Co tra tAAr:
Addr s: ' 1,100 R&d Clo 8 f3
Phone E-mail: Phone: State License Number:
Bonding Company: N�l� 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 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.
Acceptancee i1of Irmit is verification that I will notify the owner of the property of the requirements of Florida Lien
Law, FS 713.
�
T_&_!_0? SA&A r
Signature of Owner/Agent Date Signature of Contractor/Agent Date
'
Print ner/ n 's Name ' Print Contractor/Agent's Name
Signature of Notary -State of Florida Date Signature of Notary -State of Florida
. vy PHYLLIS I. GIBBON
..........4
MY OMMISSION #DD477598
EXPIRES: OCT 02, 2009
Owner/ gQaQ�}6`�t`afe°suranc°e
Pro u
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
UT1L: FD:
Contractor/Agent is
Produced ID
ENG:
Date
Personally Known to Me or
I