HomeMy WebLinkAbout302 Rochelle AveCITY OF SANFORD PERMIT APPLICATION
Permit # : C.1 I L. --� Date: O
Job Address: __3Da�, pi�014efIQ, (aVF SI/rr,C\tC} ?OLt 301 r.�r�S ail -alit �1�-�tl �?—a3y
Description of Work: 9Aa4:A 14t1 - VOM 9 z, &4FAl*sJ a 4-n 3/c S�Je rrs Go(kw 2:3 17 aa 3d'
Historic District: Zoning: Value of Work: $ S�'� l2? i `(j J CXR •DO
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 _J!�_ 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 fere other than X)
Parcel #:
Owners Name & Address:
P•o•IR� ,1-1.
(Attach Proof of Ownership & Legal Description)
Ll r4 I. 3a 1 4) Phone: `107— 3 a3 -a 4 a 8
Contractor NamU.S. & Address: • S. 4C A4n � 1 a,
/P Lt 02Y41" A't'e u�-t`f oa, t,�Ltu' S�dS 3a71 y tate License Number: C)'Y-GO—
Phone & Fax: `Mi'Contact Person: M RIZ4-i 01 f4 2r -t rL phone: Z d7'77y—S-0
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 all laws regulating construction in this jurisdiction. I understand shat 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 applic1hic ir.. _: ropulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUL I' I -N Y l )l; PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR /•.l\
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. rcrords of
this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements oUloridajeien Lave
Signature of Owner/Agent
Date Signature
17a.te
Print Owner/Agent's Name Print Co ctor/Agent's Name
2-
S
Signature of Notary -State of Florida Date Signature Notary -State of Florida Date
TRACY L. RIVERA
�--- NOTARY KMX • STATE OF FLORIDA
Owner/Agent is _ Personally Known to Me or Contractor/Agent is _' rsoB� Wally Known to QMMISSION # DD448184
_ Produced ID _ Produced ID EXPIRES 6/29/2009
D THRU 1-88&NOTARY7
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
rR
CITY OF SANFORD PERMIT APPLICATION
Permit #: n/ O ' Date:
Job Address: -�)OA Q1 A 0- µe1 Lam. iaLsL. S .c -1 3a-�7 (3 3 Oa �� s a,1 S+a il� gas -.Dal alP a35t,� 3!�
Description of Work: Qvral2, S&d i ¢d I SA, 3/e 446Ae--) g -
Historic District: Zoning: Value of Work: $ R 5-0 [o si 7lXJ•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 -b,- 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: Residentiale Commercial
Industrial
Total Square Footage:
Construction Type:
# of Stories:
# of Dwelling Units:
Flood Zone: (FEMA form required f.`ot; ct.Rr.cr than X)
Parcel #:
(Attach Proof of Ownership & Legal Description)
Owners Name & Address:
P.o• $oto t l a.v
R i me rib ryig ad a t 4
Phone: y0%— ,3x8 — GIZPA-e
Contractor Name & Address:
•5. Ik AL -c 41 Q.
l Ent-jrI-1 O
1
State License Number: 0— mcos-Co a. toe,
Phone & Fax:
Contact Person:L/d%-
Ml41�J< la'lf4l2Ti n Phone: '7711—
Bonding Company:
Address:
Mortgage Lender:
Address:
ArchitectlEngineer:
Address:
Phone:
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 lxlor to the
issuance of a permit and that all work will be performed to meet standards of all lawi 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 applicat3le Ir. : mrulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUT Tll� 1'l}I 1F: PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LL:NDI..al 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 1 klMc rcrnrds of
this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, Or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the require is of lorida ten Law
Signature of Owner/Agent Date Signature ofContractor/Agent l7 e
Print Owner/Agent's Name Print tractor/Agent's Name
Signature ofNota /�; �
Notary -State of Florida Date Signature o NotaryState of Florida Date /!
TRACY L. RIVERA
NOTARY PUBLIC • STATE OF FLORIDA
MMISSION # DD446184
Owner/Agent is _ Personally Known to Me or Contractor/Agent is Personally Known to r EXPIRES 6/2912109
_ Produced ID _ Produced ID
9(?NDED TMRU 1-888.Np7ARY1
APPLICATION APPROVED BY: Bldg:
Special Conditions:
(Initial & Date)
Zoning: _ Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date)