HomeMy WebLinkAbout309 W 5 StC� CITY OF SANFORD PERMIT APPLICATION n
Application # : d — f Submittal Date: L�
T� 2ee-(
Job Address: 3U� 4) , � — �/ Value of Work: S
Parcel ID:
Zoning:
Historic District:
Description of Work: AE l--) iRe EX/5 7,-J &- Square Footage:
Permit Type: Building ❑ Electricals Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service – # of AMPS Addition/Alteration Change of Service ❑ Temporary Pole ❑
Mechanical: Residential {Y ^ 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: Residential ❑ Commercial ❑ Industrial ❑
Construction Type: # of Stories: # of Dwelling Units:
Occupancy Use Group(s):
Flood Zone: (FEMA form required)
........................................................................................................................
PropertyOwner: W l /-` /a%So.�-� � ��3 � Contractor:
Address: ��u Jam- Address: 2D oX V2 Z f1c
I -L 3Z 7 2 S
t-lo'� %
Phone: E-mail: Phone. �r/Q, 2`/� ( State License Number: �� 2
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Lender:
Address:
Phone: Fax:
Phone:
Fax:
E-mail:
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, 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 FI rids w, FS 71 .
Z- 26 -G
Signature of Owner/Agent Date Si atur f Contractor/Agent Date
Print Owner/Agent's Name Prin6 ntractor/Agent's Name t /f///Z//
Signature of Notary -State of Florida Date Signature of Notary-Stateo` Gaya° of y 7 S FrQate�
. 45
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Owner/Agent is _ Personally Known to Me or Contractor/Agent is Pe y 61Qto,�M or .Z> I
_ Produced ID _ Produced ID / ' IS . , , �- U
APPROVALS: ZONING: _ UTIL: FD: ENG:
Special Conditions
Rev 02/2007