HomeMy WebLinkAbout304 Rachelle Ave (2)'i -
CITY OF SANFORD PERMIT APPLICATION
Permit #: D
Date:
Job Address:. 30� AAC4q, k, 4,c¢- T 1211� . R,( y.> rn I Bkoq "S 311 +312. 317 - -3.2.13-79- 3 3;t.
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Description of Work: 1 "nmo. GY ywz , 9L QR1." aj on SIC sple +c Gc( G K&-,kAeo< 33? 1' 338
Historic District: Zoning: Value of Work. $ Of SD IR l 1�1 = t t o,co
Permit Type: Building Electrical Mechanical IL
I. -Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential ` - Non -Residential
Plumbing/ New Commercial: # of Fixtures _
Plumbing/New Residential: # of Water Closets _
_ Replacement .4—, New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Occupancy Type: Residential _+ Commercial " Industrial _
Construction Type: # of Stories: # of Dwelling Units:
Plumbing Repair — Residential or Commercial
Total Square Footage:
Flood Zone: (FEMA form required for other than X)
Parcel #: / , 1 \ (Attach Proof of Ownership & Legal Description)
Owners Name & Address: UlRI4d I.omintGn
p.D• Qol� L1a.0 R t ,l, r,63 UA 2,3a lq Phone: L1017- 3x,3- a G a. _._.__.._,...._
Contractor Name & Address:
a / State License Number:
Phone & Fax: V0 O%- 77y ri/f ontact Person: Mli}QK rn A (LT"/ Y1 Phone:Lle% -17q— `PPT.0
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 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 applicatttc IriA:p rrfviating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUL:f W Y(m):; PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDGI: 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 to -cards of
this county, and there may be additional permits required from other governmental entities such as water management districts, state . ncies, ar federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements o FI ri ie
Signature of Owner/Agent Date Signature of Contractor/Agent bate
&4w ZAe-15?7
Print Owner/Agent's Name Print Cont for/Ag�Name
C y,,
Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date --
TRACY L. RIVERA
NOTARY PUBuc . STATE OF FLORIDA
MISSION # DD446184
Owner/Agent is _ Personally Known to Me or Contractor/Agent is Personall�Kn.wn toMe XPIRES 6/29/2oo9
_ Produced [D _Produced !D BONDED TNRU I-SMNorApY1
APPLICATION APPROVED BY: Bldg:
Special Conditions:
(Initial & Date)
Zoning:
(initial & Date)
Utilities: FD:
(Initial & Date) (Initial & Date)
�� CITY OF SANFORD PERMIT APPLICATION
Permit # : Q % " Lt q Date:
Job Address: 30L-1 &.1,92, 74r`n� �� 3a.n 1 30�{ A�-S l aIG 3DR 3a6 333- 33b
Description of Work: 110,01A411tnr 611 V142 nSJ) iQa I •S-iryn ale, . v ,S wl G ArW -l�. I -
Historic District: Zoning: Value of Work:
Permit Type: Building Electrical
Mechanical �_ Plumbing
Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS
Addition/Alteration
Change of Service Temporary Pole
Mechanical: Residential 11, 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 _A--- Commercial
Industrial Total Square Footage:
Construction Type: # of Stories:
# of Dwelling Units:
Flood Zone:(FEMA form required ffo a other than X)
Parcel #: (Attach Proof of Ownership & Legal Descriptlon)
Owners Name&Address: %(Ini.��i tY�Mrrn.cisv► ,
V- 01 6M'
ie�ltrY,Ovt.� ,1��4 aR A I !J Phone: _�O'%- c3e' z - a,& &<P
Contractor Name & Address: %•!J.�p.��q �i� LQ� /mn�f i-/ONt Zhu �4
]�Q(<1JAS �ecP. tt<� �— 1�1� � $� -GI Q.-7/ 4 State License Number: gen y
Phone & Fax: Y0
_ 7— -7 74 ffl-'fit 07-774(—W/q Contact Person: YT1 aQf-i /71 A 7i r► Phone: L[07--771f--9F-T-0
Bonding Company:
Address: �-
Mortgage Lender:
Address:
Architeet/Engineer:
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 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 applical.31c Ittas m ftulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUL P Mf YOU}; PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDI4I:.01 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:ublic tccnrds 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 of Florida Law-gsne %
Signature of Owner/Agent
Date Signature
Da.Ce
Print Owner/Agent's Name Print Con ctor/Agents Nam
Signature of Notary -State of Florida Date Signature of otary-State of Florida f Date --
TRACY L. RIVERA
NOTARY PUBLIC. STATE Of FLCfMK
" MMISSION # DD446184
Owner/Agent is _ Personally Known to Me or Contractor/Agent is ersonally Known to Me EXPIRES 6/29/2009
_ Produced ID _ Produced ID BONDED THRU 1-8M NOTARY1
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
�� J