HomeMy WebLinkAbout428 S Scott Ave (2)CITY OF SANFORD PERMIT APPLICATION
Application # : �'" 1 ` 3 Submittal Dater / 2 6
Job Address: -!,L y % Ros Value of Work: $
Parcel ID:`� w_n. Zoning: Historic District:
`-`
Description of Work: %uq, a. Square Footage: _
........................................................................................................................
Permit Type: Building ❑ Electrical)< Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS CP�00 Addition/Alteration ❑ Change of Service X Temporary Pole ❑
Mechanical: Residential ❑ Non -Residential ❑ Replacement ❑ New ❑ (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial ❑ Industrial ❑
Construction Type: # of Stories: # of Dwelling Units: _
# of Gas Lines
Plumbing Repair —Residential ❑ Commercial ❑
Occupancy Use Group(s):
Flood Zone: (FEMA form required)
................. ..................................................... _ .......
Property Owner: Contractor: 4� .� {�r�. Contractor.
Address: O&S SCS G Address: jwlno
Phone�� �Eq-mail: Phone: State License Number:
Bonding Company: till{a Mortgage Lender:
Address: Address:
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 additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requir m is of Fl ida Lien Law, FS 713.
6 h-7
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name Print Contractor/Agent's Nam
Signature of Notary -State of Florida Date Signature of Notary -State NMI Date
Owner/Agent is Personally Known to Me or Contractor/Agent` Q•1 ,oc nally4C+lw�o�M6a
Produced ID _ Produced ID3L�/] i 0�27q� . o
APPROVALS: ZONING: UTIL: FD: ENGI
Special Conditions: 91,�
Rev 02/2007