HomeMy WebLinkAbout639 San Lanta Cir (2)"Application #: /t )
Job Address: &1.29 11
CITY OF SANFORD PERMIT APPLICATION
Submittal Date:
slue of Worl
Parcel ED: Zoning: Historic District:
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Description ofwork p t �� t �ifoifT (cwt -( C Square Footage:
.........................................................t4CCj- 0r5irs i1 :11 .....................................
Permit Type: Building ❑ Electricals Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non -Residential 0 Replacement ❑ New ❑ (Duct Layout &Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial ❑ Industrial ❑
Plumbing Repair—Residential ❑ Commercial ❑
Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
............................................................ ................. .. . j ... T.................
Property Owner: Contractor: cJ%ol LC(�/// • •^+ �C
Address: Address�P • � _ 70S��
]tel � kid . 3017 _Q S�
7_�S('58J �G 7 I
Phone: E-mail:
Pt
a tate License Number:
Bonding Company: ortgage 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 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 maybe additional permits required from other governmental entities such as water Zmanefitt dies �cts, a encies, or federal agencies.
Acceptance of permit is verification that [will notify the owner of the property of the requi nts o to
Signature of Owner/Agent Date Si a re of Contractor/Agent Date
Print Owner/Agent's Name Prin9tg;'s Name
Signature of Notary -State of Florida Date gignature of Notary -State of Florida Date
MY COMMISSION # D N
EXPI D6$9096
-amoF
Owner/Agent is _ Personally Known to Me or Contractor/Ag t.3 rson R,B21t1
Produced ID Produced
APPROVALS: ZONING: UTIL: FD: ENG: BLDG:
Special Conditions
Rev 02/2007