HomeMy WebLinkAbout1165 W Airport BlvdPermit 9: _
Job Address: lP f-Jy 0,
CITY OF SANFORD PERMIT APPLICATION
Date:
RECEIVED
NOV 14 2006
1 a -
Description of wvork:. `'1-e SGL l^I C>Y 1 - —u no 1\] Total Square Footage_1 , SOO
Historic District: _ Zoning: Value of Work: $ t"� `J ,� • U
Permit Type: Building Electrical Mechanical Plumbing P'ire Sprinldci Alarm Pool
Electrical: New Service –# of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duet Layout & Energy Cala Required)
Plumbing/ New Commercia& # of Fixtures # of Water & Sewer Lines_ ____ # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair – Residential or Commercial
Occupancy Type: Residential _ Commercial _�,/ Industrial
Construction Type: W__ # of Stories: _ # of Dwelling Units: Flood lone: ^ (FEMA form required)
Owners Name c& Address: 'r i n
15 0 i ot6�r� (in. �s 3 14_ _ � Plume: X101 )0.
Contractor Name&Address:'V�rr-CiriC�YYt )rt' ,_ PC ( a'7 c" -
ry
V 6\ r -IC 7 L . State License Number: ��� : `1 t -AP ()` W 1 y 0 U 3
Plmotme & Fax. 3'B ')/101¢-;Sf fyi co
4'01,o7 Contact Person: CS�I�C- ILC.D-a-n Phone: I (% I- ��`iS (r�r f'
Bonding Company: v pt
Address: ---
Mortgage Leader: ry l-�
Address: yy��
Architect/Engincer: ��I1 __ Plwno:
Address: 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 constntction in this jurisdiction. I Understand that it Separate
permit mist be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify that all ofthe 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 OB'T'AIN FINANCING, CONSULT WITI l 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.
,-54910 �^iir3J (�
Signature of Owner/Agent Date Signature of Cr nt a(:tor/Agent Date
—. r% L,
Print Owner/Agent's Name Print Curitractor/Agee 's Name
t Gr/ _z.t.3\ ill :)/ 06
Signature of Notary -Slate of Florida Date Signatu - of Nota -State of Flurida Date
Q
° Notary Pri is Slane of Florida
f Jacqueline 5 Court
Owner/Agent is _ Personally Known to Nle or Contractor/Agent is ! Person; ly k?tr� mode x Iros y COm10/2i/25/i / ?0 10
0 595606
Produced ) _ l _ i__ Produced 1D
s
t NINE: "'P� - IJ'FIL: _ FD
NG: BLDG:
APPROVALS: ZONING: _ j — _
Special Conditions:
Rev 03/2006