HomeMy WebLinkAbout316 Rochelle Ave (3)CITY OF SANFOR1) PE.RNII Y APH.IC.A I'l0N
Permit Y : ) Date:
Job Address: _ �(p .. . ------501_LJ/IN-6 --�
Description of Work: Square Footage--_--
---- ------ ---
Historic District: Lolling: F-YM,RNfd7 Value of Work: S
Permit Type: Building _ Electrical NIcchanical E luntbing Fir,. SprioklcvAlarm fool
E=lectrical: New Service - N, of ANIPS Addition/Alteration Change of Sen icc Tcnmpuraty Pole
Mechanical: Residential - Nim -Residential " - - Replacement Ne," _ -- - (Duct Lavout & Energy Clilc. Required)
Plumbing/ New Commercial: ii of Fixtures P of Water &- Sewer hnc> _ _ --_. of Ga; 1-ines
Plumbing/New Residential: # old Water Closets -_ Plumbing Repair - Residential or Commercial
Occupancy Type: Residential Commercial -- - Industrial
Construction Type: It of Stories: 3 h of Dwelling Units: Flood Lone: ._ (hf:AL1 form required )
OYrners Name &Address: -V1M-T
Ito -
Contractor Name & Address:
►1i 6(A&I., Cr"L
Y'04 -'r. -- — ---
�%r�JZ' � 1 Thune.
i t �7-74 State, License Number ---
1r e
I'houc Fax: �0�. 3f°�' J � b.�_-_- _---.-- C'outact Person: 4.1M _"'�"G�p�'i� + --------Phone:
Bonding Company: ------
Address:
-� - ---------_- - --- - - "- - -- -- ----
Address: ----_------ --.---
Mortgage Lender:. -
Address -- --
ArchitecUfngincer "_--
Address.
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no i,ork or in-stallation has commenced prior to the
issuance of a pennit mid that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I undcrstarld that a separate
pernlit must be secured lou FLECTRICAL WORK, PLUMBING, SIGNS, WELLS. POOLS, FURNACES, BOILERS, IIh::1"I'L--RS, TANKS. and
AIR C=ONDITIONERS, ctc.
OWNER'S AFFIDAVIT: I certify that all ofthe foregoing intormation is accurate and that all work will be dour in compliance ,with all applicable la„s rcgulating
coils tnlction and baling WARNING] 0 OWNER: YOUR FAILURE TO RECORD A NOT ICI:: OI CONIMI:NCFMCN f \dAY RESULT IN YOUR PAYING
TWICE: POR IMPROVE -MI=NI'S TO YOUR PROPERTY- IF YOU INTI.:ND'fOOBTAW FINANCING, CONSUL -1- I YOtiR Ll-'NDGR OR AN
AT FORNFY BEFORE RECORDING YOUR NOTICE OF COMM)--'NCE:hIEN`I'.
NOIICE: In addition to the requirements of this pennit, there may be additional restrictions applicab o this property that niay be found in die public records of
this county, and there umay be additional permits required from other governmental entities such - �ar ntanagcnlent districts, state agencies, or federal agencies.
Acceptance of pennit v'erif�j:�tiou t "I I will no�tify the inner of the property of the req uiret cots of itrida Law, PS ? I i.
0.
Signatm'eofOwncr/Agent Date SignuurcofContactor/Agent Date
ChA44,5 6.60,nt
Print O„nci/Agcnt's Name P u ContrtaollAgent's N�G �} _
ZS-oLe 1b���
Signature otNotary-State of-rMOrrdn- Date Signature of Notary -Stale oto lorida
7Te 2C'4s CARMEN RIVERA
I pftY Nlr�!%��
1 , .
s
IRENE FUENTES
Notary Public, State of Texas
Expires
�s�� _ Notary Public, State of Florida
$ �mmi�o�ppg1t3783
' "
My Commission
'no to Comm. e%Rfres Feb. 21, 2011
�y�1rj `
O,vrterlA,ent is _✓ Pesmmauy Known t kiw
February 17 ; PDtI'A for/'\ge, is -.._ Pcrsomdly
II1Ry
Produced
APPROVALS: 'ZONING: ---.---- [It'll.: ---!'D:
_--------.----._.__-- I --.NG: _ —.---
BLDG:_._-.
Special Conditions
Rcv 03J2006