HomeMy WebLinkAbout306 Rochelle AveCOIN Of SANI, ORD PF.RNIFF APPLICATION
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,to A.ddress:Gq$-I-GA�t�L�
cscription of Work:-0..l_GOfLl.V R., p-&-cC oTe-n 7 —total Square Footage
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istoric District: _ Zoning: Value of Work: S
:rntit Type: Building -� I31c:ctricA --- Mechanical _ Plumbing Firc Sprinklcn/Alava fool
ectricaL New Service - # of AMPS !�l►'f Addition/Alteration Change of Service -- l-crnporary Pole
echanicaL Residential �� Noir-Residential __ Replacement - _ New _ _ (Duct Layout & Lnergy Calc. Required)
uarbing/ New ContnterciaV H of ?Fixtures AJA_ II of Water & Sewer Lincs Il of Gas Lines
umbing/New Residential: # of N!`ater Closets N�� Plumbing Repair - Residential or Coniunerciai
xupancy Type: Residential � ;_ Commercial Industrial - -
instruction TypeWO-D-Q_ H ql;f Stories: 3 t! of Dwelling Units: Flood Zone: (FEMA form reyidred )
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YII e1"S Nall d'(. Address : ��_ e_�11—�=-fJ--o'-i-lylr 6J t� �y -_— _o0 4.__C4 /_y
Phone
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�na'actor Namc &Address. (id,S 1 -1' S� G•- A- --- [� -----
--- - __- _State License Number: _ CG -C 0 — - ---
one & Ga[ 0•Z ontact t'cr'sun . J'� —Phone
Sou •ggp _TL9 9 -8 $ 7_ P _-(3 13�r_n i►a. )4 jjlV6�� Z Z %
riding Company: ---
(dress: — — ---_ -- — --
)lgage Linder: -- -- ---- ----- ----- -- — — --- -
.dress: --------- ---- ------
chilect/Engineer: -- ----------__--- — _ Phone.
dress: -- — Fac: ----- ---
plication is hereby made to obtain a p' rmit to do the work and installations as indicated 1 ccntify that no work or installation has commenced prior to the
ranee of a permit and that all work willl be perfontrcd to meet standards of all laws reguiating constuction in this jurisdiction- I understand that a separate
mit nmst besecured for ELECTRICIL. WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, 1IEA"FERS, YANKS, and
t CONDFFIONE16, etc. U
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dNF R'S AFFLDAVFF: I certify that al ofthe foregoing infonnation is accurate and that all work will be done in compliance with all applicable laws regulating
tstntction and zoning. WARNING TO OWNER= YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUL-I IN YOUR PAYING
TICE POR IMPROVEMENTS TO Y(0)UR PROPERTY. IF YOU INTEND "1'0 OBTAIN FINANCING, CONSUL: T WITfi YOUR I.I:fNDI:R OR AN
FORNEY BEFORE RECORDING Y40UR NOTICE OF COMMENCEMENT.
1pCE: In add^ to the equiremene' this pctrntit, there may be additional restrictions applicable to this property that may be found in the public records of
'county, may addition ) nits required from other governmental entities such as water management districts, state agencies, or federal agencies.
;eptance o pemr i3 ern r i I ill notify the owner of (tic property of the requirements of Florida Lien Iaw, FS 713.
Signature o ryr/Ag tt Da Signature of Contractor/Agent D.u.c
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Pit t 0 c A cat's Name 4 Prin Ir c (/Agent's Name
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Signal o olary-State of Florida �ifl 8IONF' ,y i Sn ore Notary -State of Florida ale \\\ �`�'••••••..••S'� ///
Z9 CP 13,
41
2'• #DD 418176
Owner/Agent is " Personally Known to IvlContactor/Agent is __1personally Known to Mc or Z #DD 418176 ; p
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I roduccd ID __ � q •.�yeorMedtnt`s•' � • •cgs
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?ROVALS: ZONING: _ C117L: FD: _ ENG:
tial Conditions: V
03/2006 \