HomeMy WebLinkAbout4405 St Johns Pkwy (3)CITY OF SANFORD PERMIT APPLICATION
Pertmit # :Date:
Job Address: —IGi� J Jl� ii� 3 t�1 i f�� (CY i -.. e�
Description of Work: KQQ`T / S V ty t` C ?W5f • 10 /. U,11(7'7 Total Square Footage � rig 000 �`1
Historic District: Zoning: Value of Work: $ b ` �O , Z DO
Permit Type: Building Electrical
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential — Commercial
Mechanical Plumbing Fire Sprinkler/Alarm Pool
_ Addition/Alteration Change of Service Temporary Pole
— Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair — Residential or Commercial _
Industrial
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
Owners Name & Address
Contractor Name Address
T
Phone & Fax: 9i 1 7�3 --
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Contact Person:
Phone: _
/L
Phone:
Fax:
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: 1 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 requirements of Florida Lien Law, FS 713
2° (-3-0-7
Signature of Owner/Agent Date gnature of Contractor/Agent Date i ,t
,_.
Print Owner/Agent's Name Print Contractor/Agent's Name
Signature of Notary -State of Florida Date Signature No -State of Florida Date
Owner/Agent is _
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
Personally Known to Me or
UTIL:
FD:
Contractor/Agent is _Personally Known to Me or
Produced ID
ENG: BLDG:
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