HomeMy WebLinkAbout301 W 10 StCITY OF SANFORD PERMIT APPLICATION
Application # : Ot� � 1
Job Address: V) l J • REE �ANFO?.b � ft, ' 2
Parcel ID: �_G – �� Zoning:
41 to
Submittal Date:
Value of Work: $ �e
Historic District:
Description of Work: K& -V E L_1 N & Square Footage: 2c�
.......................................................................................................................
Permit Type: Building ❑ Electrical Mechanical ❑ Plumb' ❑ Fire Sprinkler/Alarm [3 Pool ❑ Sign ❑
Electrical: New Service – # of AMPS �fCddition/Alteration V 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: 2- # of Dwelling Units: Flood Zone: (FEMA form required )
...................../................................................................................................
I -
Property Owner: 611 16LANj�TCT I Contractor: -701 /�Vcl )��/ � fit
l' ,
Address: �jci �L�–�f�1Cs��ty 1'\L£ dd Aess: ! 1I MI �fCt✓
LI, G 7�
Phone:��i2� 2�C)0 E-mail: PhoneYDI –36&'' State License Number:
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Lender:
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 additi ermits required from other governmental entities such as water management districts, state agencies, or federal agencies.
7S;iat.rof
nfication '11 notify the owner Ztheperty of the requirement of Florida Lien71�7 y
ner/Agent Date Signa e o Contractor/Agent Date
Print Owner/ gent's Name P ' Contractor/Agent's ame
&��_3/a�a17 �� 4
ignature of Notary -State of FlorisDate Signature of Notary -State of Florida Date
,W-►cy, Claudia A Bosquez
My Commission DD337930
OF M1dg Expires July 14, 2008
Owner/Agent is XPetsonally Known to Me or
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
UTIL: FD:
4F
Contractor/Agent is Petsonall ; 4, �. fl 6 '
Produced m —� z" �� 3'
ENG: •BLDG• ¢ —
PIJ
L�
��� din r,ISP tff�V'�. •``�