HomeMy WebLinkAbout314 Rochelle AveCft'Y OF SANVORD PERA41T Al'PLICAI [ON
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h .Address: / 77/
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scriptinn of 1Vork:Uotal Square footage_._—.
istnric District.Zoning: ----- - Value of Work:—. --
:emit Type: (3uilcting UAIX(rical Mechanical I'lumbinl, Vire Sprinkler/Alarm fool
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ectrical: New Service - H of AMI'S N1 �'f_ Additiott/Altcration Chang:: of Scrvice temporary Pole
eehanical: Resident::d /� Non -Residential Replacement New .. (Duct Layout & l uci y Gale. Re(uired)
umbing/ New Commercial !t of fixtures _V-/ .hof Water &Sewer Lincs t! of Gas Lutes _
untbing/New Rcsidentiaf: /I of Water CloscLs R- - Plumbing Repair -- Residential or (_'ommerctal-
zcultancy 7 ype: Residential 00 .- Conuncrcial ��"-- Industrial -
instruction Typewpp.0 --- H of Stories: 3 N of Dwelling Units: Flood Lone. (FEMA form required )
vatrs Name & Address'
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uuractor Name & Address
License NlumIPcPr
one & hae: �_'Rd .�71� ,._._=1. SBt%•Z�27'antact 1'trsott. _..�•'" _/_.t!i./11Lt17t T........._Phonc ��7� y6�•_L�(i7
riding Company:
it(L;kgc fender: -----
dress:
chifec14,,agineer. _-..
dress.
('hone.
Fax'.
plication is hereby made to obtain a lu:nuit to do the work and titsLal Iattons m indicated I ecrti(v that no work or installation has conuncnccd prior to tltc
,ante of a permit and that all work will be performed to m,xl standards of all laws regulating coastn,cuon in this jurisdiction. I understand that a separate
ntit must be secured for IiLEMICAL WORK, PLUMB(NG, SIGNS, WELL'). POOI.S, fURNACFS, 13011.GRS, 111: Al -FRS, TANKS, and
( CONDINONEWS, dc.
JNF>IZ'S AFFIDAVCf: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
tstnrction and caning. WAI(N(NG T(:) OWNER: YOUR FA(f.URF TO RF -CORD A NO'I'(Cl; Of COMMENCEN(FN'I' MAY RESULT IN YOUR PAYING:
rICF f -OR IMPROVCM1:KFS TO YOOR I'I(OI'FRI-Y. IF YOU INTEND 1.0 OFYIAIN FINANCING, CONSULT WIT -if YOUR I.FNDGk OI( AN
TORNEY BEFORE RECORDING YOUR NO1'ICF: OF C0biM1 NCf:MIiN1'.
'T(CF: In ad,
; county.. and
xptance of
Owncr/Agent is Personally Klujwn
Produced IT)
'ROVALS: ZONING'.
tial ('-Mwitious
03/2(106
lftere may be additional restrictions applicable to this property that may he found in (ltc public reccxds of
I from other governmental entities such as water ntanageutent districts, soot agencies, or federal agencies.
the property of the requi ' ntcnis o (orida Lien Law, 1'S 113.
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D:uc IPA Signature Of (.oatt actor/Agc Date
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Date O •••.. S //
Contractor/Agent is _ . Pcrsn,tal(y Known
to fvic or : #DD 418176 : O
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