HomeMy WebLinkAbout301 W 10 St (2)CITY OF SANFORD PERMIT APPLICATION
Application #: i�i1 Submittal Dater
Job Address: 3Q\ %010- SN- Value of Work: $ QC s =-
Parcel ID: Zoning: Historic District:
Description of Work: t� -jai ��� A^�,—cn Square Footage:
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Permit Type: Building ❑ Electrical ❑ Mechanical 0 Plumbing GY"' Fire Sprinkler/Alarm ❑ Pool ❑ Sign E3
Electrical: New Service —# o " S Addition/Alteration 13 Change of Service ❑ Temporary Pole 13Mechanical: 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: # of Dwelling Units: Flood Zone: (FEMA form required)
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Property Owner: \JVZ aE Contractor: -`1Y)
` Address: c� ' w"1n .Si- Address. '-N00 S s""&L
Phone:
Bonding Company:......,
. Address: .
E-mail:
Phone: AA (M OYI State License Number: CkZ,0.ti J�J
Mortgage Lender: _....
Address:
Architect/Engineer: Phone:
Address: Fax:
Plan Review Contact Person: 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
t ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.: .
i 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
i this county, and there may be additional permits required from other governmental entities such man ement districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirem is o lorid Li 1w, F
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Signature of Owner/Agent Date Signatu of Co_—)
ntrac t Date
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Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
_ Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
UTIL: FD:
Pri Contra�aUAgga 's Name
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Signature ofNotary-S a • » . //gate
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Contractor/Agent iik O vl3>isttey` IhrouIq°�vt�e�O�
Produced ID •�, x?r .!
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