HomeMy WebLinkAbout419 Park AveCITY OF SANFORD PERMIT APPLICATION
Application #:_0 Submittal Date:
Job Address: �� UPUC.0 Value of Work:
Parcel ID:
Historic District:
Description of Work: Aue C
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Ot a,45Square Footage: IT7�f-c�)
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Permit Type: Building ❑ Electrical ❑
MechanicwjlT Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS
Addition/Alteration
❑ Change of Service ❑ Temporary Pole ❑
Mechanical: ResidenV511`�o"nesidential
❑ 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
Plumbing Repair — Residential ❑ Commercial ❑
Occupancy Type: Residential ❑ Commerciabd---Industrial ❑
Occupancy Use Group(s): M, -c
Construction Type: '4_Z— # of Stories:
# of Dwelling Units:
Flood Zone: (FEMA form required)
....................... .................
Property Owner:
• • .... .......................
...... ........................
Contractor: • • l r�"-�
Address:
Addr
Phone. E-mail:
Phone: State License Number:
Bonding Company: .. _.....: .,,
_..
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
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State
Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
Signature of Notary -State
Contractor/Agent is
Produced ID _
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CITY OF SANFORD HISTORIC PRESERVATION BOARD
APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
P.O. Box 1788, Sanford, FL 32772-1788
Phone: 407.302.5805 Fax: 407.330.5679
TO: THE HISTORIC PRESERVATION BOARD OF THE CITY OF SANFORD, FLORIDA
0 Downtown Commercial Historic District ❑ Residential Historic District
0 This application is filedin response to a/notice from the Code Enforcement Department
'
ADDRESS OF PROPERTY: �t/q 01"/ 14)110
Signature:
Mailing Address:
• - �rryQ7A]w4r
Print Name: , "" -
Signature: ���� Print Name:
Mailing Address: RJZV �q XP 4,,(r— AV
v
Phone: %� Z� Z /Z 2- Fax:
I certify that all inform io co in in this application is true and accurate to the best of m kn ledge.
Applicant/Owner: Date:
Please use the attached criteria 4 ecklist as a guide to completing the application. Incomplete applications cannot.be
reviewed and will be returned to you for more information. You are encouraged to contact the preservation planner at
407-330-5672 to make sure your application is complete.
Description of Proposed Work/Application Category: (Check all that apply)
❑ Site Improvements/driveway/walkway ❑ Storage shed ❑ Moving structures
D Replacement. windows or doors ❑ Underskirting ❑ Awnings
❑ New construction/additions ❑ Signs ❑ Demolition
❑ Roofs/gutters/downspouts ec anical ❑ Fences/Gates/Pergolas
❑ Replacement siding/flooring/porch ❑ Paint ❑ Other
Completely describe the entire scope of work: all changes in material, color or location to the exterior of the building,
where on the property the work will occur and how the work will be accomplished. For large projects, an itemized list is
recommen d. Attach additional p ges if neces ry.
A Certificate of Appropriateness is valid for six month nless otherwise noted
OFFICIAL USE ONLY
Historic Preservation Board Meet* ate:
Application is Approved
Conditions:.
Signed
Approved with Conditions
Date:
Staff Review Date:
Denied
***This Certificate must be prominently displayed on the building when work is in progress***
Requirements for Certificate of Appropriateness Application