HomeMy WebLinkAbout306 Rachelle AveI'1
CITY OF SANFORD PERMIT APPLICATION
Permit
Date:
Job Address: 3C60 VICV2- 611.0 kf= SAMr, . CSA zt ��777 (
Description of Work:
Historic District:
Zoning:
Value of Work:
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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-ResidentialReplacement New (Duct Layout & Energy Cald. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair - Residential or Commercial _
_#yia-
?- `139.
Occupancy Type: Residential �:6,_ Commercial ` Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required iot other than x)
Parcel #: /, 11 -- (Attach Proof of Ownership & Legal Deserlptlon)
Owners Name & Address: ( tUXA 11 nYlrt LYS t D h
P.D. 21191 1 LAA R te-6rynn I Uro a-3at !' Phone: LIC7- 3.\J— cV a e
Contractor Name & Address: %1. ,S, P I L (Per'd'110h I M t ,T y--
[D�l �tyS Lle_t 1tFoa. QPM -S SS �I 3a7/y State License Number: COS�v a.qO
Phone & Fax:Qa -MV17- 7W_yy/ q Contact Person: MR 24-� m 14 R rl y\ Phone: _D] %7
� Y-9,fso
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/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 applicable Is. ; s rrpulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUL:I' M Y01)11, PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LLNDEk 011 /:N
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 pu:bl Ic rcr«rds of
this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, ar federal agencies. .
Acceptance of permit is verification that 1 will notify the owner of the property of the requirements Florida en
Signature of Owner/Agent Date igna re of Contractor/A nt w Date
Print Owner/Agent's Name Print on ctor/Agen 's Name
Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
_ Produced ID
APPLICATION APPROVED BY: Bldg:
Special Conditions:
(Initial & Date)
TRACY L. RIVERA
NOTARY PU80C - STATE OF FLORIDA
COMMISSION # DD446184
Contractor/Agent is ersonally Known to or EXPIRES &29/2pog
Produced ID BONDED THRU t-a°a NOTjkRYt
Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date)
06
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CITY OF SANFORD PERMIT APPLICATION
*Permit # • 0 /-' � % �
' ,,/ Rn Date: _
Job Address: 3 do Aa4e e 1l- SAm si - Sl A -5.4 -n1 _
Description of Work:t ,nom L InQD,� (, Kldk4a>'reS �.3oG .Qd-s �P33 yn y/y– 914
Historic District:
Zoning:
Value of Work:
5'0A 11. 111 Cleo
-00 � tia4
Permit Type: Building
Electrical
Mechanical *-, Plumbing
Fire Sprinkler/Alarm
Pool
Electrical: New Service – # of AMPS
Mechanical: Residential r Non -Residential
Plumbing/ New Commercial: # of Fixtures _
Plumbing/New Residential: # of Water Closets
Addition/Alteration Change of Service Temporary Pole
_ Replacement 4— New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Occupancy Type: Residential_ Commercial Industrial
Plumbing Repair – Residential or Commercial
Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required cor other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: ._lJFOr
E0 I&FIN 1116
Phone:
Contractor Name & Address: �{ •S. hiC i- IQ 1 IZ d1 �t i ld h t Vl r 1
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