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HomeMy WebLinkAbout309 Rachelle AveCITY OF SANFORD PERMIT APPLICATION Permit # : 0 / 1 Date: el Job Address:.�Dq_�iAGN�IIn Qt'ri,� SAn�.�i ���� -3a1 Cvyn-lura-G�3-iolN-�►1-4, e 6aI-62o day Description of Work: t16i 13/�/ e460hy.42 c—��1 iet4 A &,n a l� S74,,--i�Total Sq a e�ootaagge�� 33�[o�elG G3G - Historic District: Zoning: Value of Work: $_q,iD e) :)(1 �-t k / , © .SV •p0 Permit Type: Building Electrical Mechanical `( Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole Mechanical: Residential -L- 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 �— Commercial Industrial Construction Type: � #/0 of Stories: # of Dwelling Units: Flood Zone: (FEMA form required %) Owners Name & Address: 1.1 n 142 1--,i Yr I ✓) I oa O, d o'k, I I A t- R I�h m l b Us¢ a 3� I q Phone: -Vo Contractor Name & Address: Id, 5, Ile r.>. I- lQ 1 a rP31 be ie AX / }fes. .tb/V-1d. All <,--1ps , .rl 3-,71 State License Number: Phone & Fax: 07' i7� 9��1y6/'!?� `�yl g Contact Person: M P -R rs ✓HAP-rI Y► Phone: 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 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,` 1tere may be additional restrictions applicable to this property that maybe 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 a encies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirem o I rid ie 7 . Signature of Owner/Agent Date Signature of Contractor/Agent Date Print Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is` Personally Known to Me or Produced ID APPROVALS: ZONING: Special Conditions: Rev 03/2006 UTIL FD: MARr5 rna,Rrl0 Print Contractor/Agent's Name ID Sign o - tate of Florida Date a7B0®00009009109A60009a1691180a�,�®Ce,®06 P@Y Po / NVE KONFORTE m Coira:pior eQt?' _e ' o Me ori m Prpduce 9110r w Florida N r Acen., Inc. �eueoae®000emoa®noaao©eoo'auaooaaaoaan�r ENG: BLDG`. �r M 1 �