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HomeMy WebLinkAbout512 Sanford AveCITY OF SANFORD PERMIT APPLICATION Application # - � ©� Submittal Date: O Z/1 5 `O _ R ! Job Address: D I 5' a4U P_' Value of Work: $ l•7� V ^ � Parcel ID: Zoning: Historic District: B 1 5 Z00% Description of Work: s��/ &I-CA191 A/04n Square Footage: Permit Type: Building ❑ Electrical ❑ Mechanical Plumbing ❑ 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: It of Fixtures # of Water & Sewer Lines # of Gas Lines Plumbing/New Residential: # of Water Closets Plumbing Repair - Residential ❑ Commercial ❑ Occupancy Type: Residential ❑ Cornrercialiot,._ Industrial ❑ Occupancy Use Group(s): Construction Type: # of Stories: _� # of Dwelling Units: Flood Zone: (FEMA form required) Property Owner. rgr.-I uj 1 y� Contractor: (A. 14 Address: J`yb Lf Rn w Address: Phone: E-mail: Phone:&;ka o tate License Number. Q10V IE Bonding Company: Mortgage Lender:' Address: Architect/Engineer: Address: Plan Review Contact Person: _ 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 IM[PROVEMENTS 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, restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits requi entities such as water management districts, state agencies, or federal agencies. 0M is Acceptance ofp�;#ATerific#io9,ty I w040tiA owreB�Kop pW04requirements of Florida Lien Law, FS 713. Signature of Owner/Agent= • ; Q e o • 1= O � o Signature of Contractor/Agent Date Pri er/A ent' are i ' aoo- e� 11' . A. � g / C� B �p �� . Print Contractor/Agent's Name Signature of Notary -State of Florida `\ Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or — Produced ID I APPROVALS: ZONING: _ UTIL Special Conditions: Rev 02/2007 Contractor/Agent is _ Personally Known to Me or - _Produced ID 03��� V' FD: / !� aq ENG: BLDG: Al oo. c) 1) CITY OF SANFORD FIRE DEPARTMENT FEES FOR SERVICES PHONE # 407-302-1091 * FAX #: 407-330-5677 DATE:p1 P RMIT #: BUSINESS NAME / PROJECT: US y� ADDRESS: PHONE NO.: ��� FAX NO.: CONST. INSP. [ ] F. A. [ ] F.S. TENT PERMIT I ] TOTAL F S: $ COMM . N C / O IN SPECTION [ ] PLANS REVIEW [ ] [ ] H D AINT BOOTH [ ] BURN PER [ ] TA ] OTHER K]' I : e,1 (PER UNIT SEE BELOW) 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Fees must be paid to Sanford Building Department, 300 N. Park Ave., Sanford, Fl. 32771 Phone # -407- 330-5656. Proof of Payment must be made to Fire Prevention division before any further services can take place. I certify that the above is true and correct and that will comply with all applicable codes and ordinances of the City of Sanford, Florida. Sanford Fire Prevention Division Applicant's Signature