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HomeMy WebLinkAbout314 Rachelle Ave/` \ CITY OF SANFORD PERMIT APPLICATION Permit #: b � _ I A Date: � — Lq— Oq JobAddress: 31q 0,--AELLr J,7 -i -54h V GIA 5a-7lc-f 6 -3/g01011 -Iola 1013 Io10 /ois /olh ibis-ya�l -J J10'J-X- loa3- Ibau_ Inas- Ion/ / ..1.19.11111111111 X1111■;K\� .]_!�-��-��Y+.[� >•��,r�I�SS!!f�]i��� 1 MM t Zoning: Value of Work: ID3l—lana-cod �� 3y D,l4om o©1�3a' Permit Type: Building Electrical Mechanical -3-- Plumbing Fire Sprinkler/Alarm Pool _ 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 or Commercial _ Occupancy Type: Residential 11�-- Commercial Industrial Construction Type: �# of Stories: # of Dwelling Units: Flood Zone: (FEMA form required ) Owners Name & Address: (/ n__1_ f� ItJh?}1 J;YI- 1 r5 Q r ,69`� IAO Phone:`t*�i-,��.�-a�o3J' Contractor Name & Address: (�-!(�g, a n c ,Ll-rl0� o (J7!!7t /O� p � �-/ 3.2 71 y State License Number: ( YYI e O Seo a yO Phone &Fax: ( 76�- �%�/ Qj Contact Person: � ZM 41?7- IV) Phone: V f7- % Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Phone: Address: 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. 1 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 a encies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirem Lien �� g7 Signature of Owner/Agent Date Signature of Contractor/Agent Date I" 4 &A-R� Print Owner/Agent's Name Print Contractor/Agent's Name .;� 140Aek --a-/ I - '2 Signature of Notary -State of Florida Date ature otary-State of Florida Date leeoa0000aae oao©aoueeaoeoanoaeeooeseoa Owner/Agent is _Personally Known to Me or Contracto�l Y v r Persona l�M m Produced ID _ ProdWe IDPiree _ 8� "150 ,EF Bonded thtu (300) 432.4254 oR p Florida NotaAssn., Inc. APPROVALS: ZONING: UTIL: FD:„„„) %i.C;,.„� Special Conditions: Rev 03/2006 !V No