HomeMy WebLinkAbout304 Rachelle Ave (3)\ ? JCITY OF SANFORD PERMIT APPLICATION
Application,# : L99 1 —J //
Job Address: / 3 7 CSS" / t e- Ile
Parcel ID' `sem ! !04 727"7
Zoning:
Submittal Date:
N\e uq- I �":sl
Value of Work: S / 3, 60 S , Ld
Historic District:
Description of Work: 12CSquare Footage:
Permit Type: Building g Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
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 ❑ Commercial ❑
Occupancy Type: Re's'idential A. Commercial Industrial ❑ Occupancy Use Group(s): Sono -F.,
Construction Type: 66A# of Stories: -_�_ # of Dwelling Units: Q4 Flood Zone: (FEMA form required )
..........................................................................................................................
Property Owner: Contractor. V l* -C` - Cp» S 4,1vL d, A 0'eVj(e,1.
Address: Address: --770]S-3
IA -F7 7
Phone: E-mail: Phone: C _ To%Jfl f State License Number: (-6-6 LSO R% �_
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address: 0, 0+ d 2, /Y 3& 6 Sd✓ ��Q r_1 11 I
Plan Review Contact Person: Phone: Fax:
Phone:_ '3�% �b�- U%%y
Fax:
E-mail:
Application is hereby made to obtain a permit to do the work and installations as indicated. l 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 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 F!19 ' a Lien La 713.
7
Signature of Owner/Agent Date Signature of Contractor genu Date
Print Owner/Agent's Name
Signature of Notary-State'of Florida
Owner/Agent is _
_ Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 0212007
Personally Known to Me or
Date Signature of Notary-Stato4f %f4a�
� • �s�4'n 2
/ 800-385�� • QT,
Contractor/Agent is Persoc�
Produced ID +S
FD: ENG: BLDG:
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