HomeMy WebLinkAbout319 Elliott Ave 07-675 (run gas line)�j CITY OF SANFORD PERMIT APPLICATION
Application # : " �" Submittal Date:
Job Address: 2/7 Value of Work: $ /nod
Parcel ID: Zoning: Historic District:
Description of Work: %w n 6-5 e/-� Square Footage:
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Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing 0 Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
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 g3
Plumbing/New Residential: # of Water Closets Plumbing Repair— Residential ❑ Commercial ❑
Occupancy Type: Residential Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
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Property Owner: D rA a I' d Contractor: I -IJ G-3 P�O41q
Address: ai 9 C Address: ;2.2ro
32--7 3IT
Phone: E-mail: Phone Y71 _ 1/T!�_State License Number:
Bonding Company:— Mortgage Lender:..,...... _.. .
Address: - Address: r- .-
Architect/Engineer:
Address:
Plan Review Contact Person:
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 addition permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit . verification will notify the owner of the property of the requirements f Florida Lien w, FS 713.
ti
I of Owner/ gent ate ignatureof ontractor/Agent Date
4Jzn, ef 3ro 7
Print Owiter/A Name P 'nt Contractor/Agent's N Ue
313ol
Signature of Notary -State of Florida Date ature $�rNota�ry-Sta 6J?J �a 0HNSON Date
* MY COMMISSION I DD 285622
EXPIRES: March 23, 2008
Bonded Thru Budget Notary Services
Owner/Agent is _ Personally Known to Me or Contractor/Agent is _ sona4yKnown to Me or
Produced ID oducedID(�
APPROVALS: ZONING: UTIL: FD: ENG: BLDG:
Special Conditions:
Rev 02/2007