HomeMy WebLinkAbout520 Bella Rosa CirCITY OF SANFO_ RD PERMIT APPLICATION
i Application N: S oZ a /2 3 /��
Submittal Date:
Job Address: o2blI 14 �S¢� Value of Work:
Parcel ID: y 1 r pZoning: Historic District:
Description of Work: cS%uG"1 j JW1 2Gc4�1� (`id0 J— Square Footage:
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Permit Type: Building ❑ Electrical 0 Mechanical ❑ Plumbing. 19Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service.— # of AMPS Addition/Alteration O Change of Service 0 ` 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
i Plumbing/New Residential: # of Water Closets Plumbing Repair —Residential ❑ Commercial ❑
e 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 Owners �flAFl^ M-rc Nd MIS Contractor: 3ad 040-04 TKf
Address: Address: c2% L11 ,"K i0 � 5i4, i C
1 3263
€ Phone. ` E-mail: Phone: 3'I State'License Number: L �'�"� 33
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Bonding Company."' ° `.` ""," Mortgage Lender:'
7: ,. .
=Address:='
_ ...Address.`'°
Arch itect/Engineer: Phone:
Address: Fax:
Plan Review Contact Person: Phone: Fax: E-mail•
i
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
i permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
E 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
E 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 additionaFrestnctions applicable to this property that may be found in the public records of
i this county, and there may be additional permits required from other governmental entiti uch as water man me districts, state agencies, or federal agencies.
'Acceptance of permit is verification that I will notify the owner of the. property of the qui emen f FI a AS-
Signature of Owner/Agent Date Signature of Contracto
a'y
Print Owner/Agent's Name rin Contractor Agent's N 7¢
n.r 1,•/
Signature of Notary -State of Florida : Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING:
Special Conditions:,
Rev 02/2007
UT1L: FD:
Signature of Notary -State of isAt'� 6� �.IaYea
Contractor/Agent is wn to Me or
Produced ID
ENG: BLDG: