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HomeMy WebLinkAbout300 Rachelle Ave (2)e �j CITY OF SANFORD PERMIT APPLICATION Permit # : -7 — i` Date: Job Address:30o 0 AC04 L-kAIAQ. S,4r.r.,C) :Ri-77► Vii,.- R, r,- A,^L, iit+'rtU i14-', Description of Work: k0d Olt Via QWM a ILsC�ppl i ed a n 3/c S 4 4 rnf Lc./ wI A&U Je,a t - Historic District: Zoning: Value of Work: $ 1q,57e R ¢n 4n • 06 Permit Type: Building Electrical Mechanical_ Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole Mechanical: Residential I_ Non -Residential Plumbing/ New Commercial: # of Fixtures Plumbing/New Residential: # of Water Closets Replacement -q_ New (Duct Layout & Energy Calc. Required) # of Water & Sewer Lines # of Gas Lines Occupancy Type: Residential A— Commercial Industrial Plumbing Repair - Residential or Commercial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: /' 1 \ (Attach Proof of Ownership & Legal Descripti.on) Owners Name & Address: UY-AAr� SY�wtr r1r en P•o (ba-, 11 \.0 R�C�+vrtonD► V,a a ala Phone: 407- 3a3 -A& Xe Contractor Name & Address: lj, 1 -be d a l �� [p•r�hjt�-►ont r �I/1G _m„ '- %a4 'ho State License Number. (2 VY1Gosr- ALLO` Phone & Fax: 167-7-71WSZ 1/07711 -Lull !j Contact Person: M(P-R-0- M f3.2T-) 10 Phone: Bonding Company: Address: Mortgage Lender: Address: ArchiteeUEngineer: Phone: Address: 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 geparate 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 applicabIc ImvF rcfvlating construction and zoning. WARNING TO OWNER YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY REWLT Ili 1'01)1: PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LLND1S11 Oi 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 agen�ederal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirements of"riga Wn Lawes',$ 7.13T Signature of Owner/Agent Date Print Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is _ Personally Known to Me or _ Produced ID APPLICATION APPROVED BY: Bldg: Zoning: (Initial & Date) Special Conditions: Stgnatue of Contra ctor/Ag Date I/ Print Co ctor/Agent�kName i Signature of Notary -State of Florida Date -- TRAC`:' RIVERA NOTARY PUSUt; STATE OR FLORIDA �� COMMISSION # DD446184 Contractor/Agent is _� rsonally Known to Me B(PIRES, 6/29x"9 _ Produced ID BONDED THRu i4mw4 OTARYt Utilities: FD: (Initial & Date) (Initial & Date) (Initial & Date) 0- 1 t qlod qCITY OF SANFORD PERMIT APPLICATION Permit # -D 1 Date: Job Address: 200 J AC 4e] le, Aut- SAtnLoR b l&S 1 '. (rltj�l S l 01 le Description of Work: 1404trlu GIIrXl1¢R.. S& xocl S{w 31e, S c4 cel 1 k-4 (o AW 14e Ar Historic District: Zoning: Value of Work: s --,i 5-0 y,•L{ = 33"?e,0-00 Permit Type: Building Electrical Mechanical_ Plumbing Fire Sprinkler/Alarm Pool 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 or Commercial Occupancy Type: Residential_ Commercial Industrial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone:(FEMA form required fern entPrcr than X) Parcel #: (Attach Proof of Ownership & Legal Description) Owners Name & Address: uy,111A DzMa ty% on 9.0,6ct, (12,0 KC)AYb\19 Phone:_3al- 35-6- 3939 Contractor Name & Address: U - S. Ile p-� taI l On©"I Dnnni The 4 weS '*' 1 347i State License Number: IF nx-- S-& -\ t-(� M Phone & Fax: -7A(- So --77V- 4W 9 Contact Person: VY) rz am M rl ,21"% h Phone: 707- 7W -9e J-Z�l Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Phone: Address: 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 ail 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 ofthe foregoing information is accurate and that all work will be done in compliance with all applicable la , : regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT D� Y0111 PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LLNDI l 01), !:h 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 Iru.blic mcnrds of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, at- federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirements o tori ie Signature ofOwner/Agent Date Signature of Con ctor/A,,tt 'A Date Print Owner/Agent's Name Print Con for/Agen 's Na- w Signature of Notary -State of Florida Date Signature o Notary -State of Florida Date - TRACY L. RIVERA Owner/Agent is _ Personally Known to Me or Contractor/Agent i Personally Know ' NOTARY PUBLIC - STATE OFFLORIDA Produced ID Produced ID WMMISSION # DD446184 EXPIRES 6!29/2009 BONDED THRtr 1.IMNOTAPYt APPLICATION APPROVED BY: Bldg: (Initial & Date) Special Conditions: Zoning: (Initial & Date) Utilities: FD: (Initial & Date) (Initial & Date) tr