HomeMy WebLinkAbout165 Towne Center CirPermit #
Job Address:
Description of Work:
CITY OF SAN FORD,fJ,1 ERr IIT APPLICATION
Date: G �_
Historic District: _ Zoning: Value of Work: S ,� 5`"J
Permit Type: Building _ Electricai Mechanical Plumbing Fire Sprinkler/Alarm ! Pool
Electrical: New Service — # of AMPS J_,_ Addition/Alteration Change of Service Temporary Polo
Mechanical: Residential Non -Residential Replacement New (Duct Layout & L'nergy Calc, Required)
Plurnbing/ New Commercial: # of Fixtures # of Water & Sewer Lincs # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing .Repair -- Residential or Commercial
Occupancy Type: Residential _ CommercialIndustrial __ Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood 'Lone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Contractor Name & Address:
( 3_—)Ut /1J.
(Attach Proof of Ownership & Legal Description)
State License Number: �O S U lU/ ZQd
Phone & Fax: 1/0?- Contact Person: _ yC�/c�6t /rUY! (C- Phone:
Bonding Company:
Address:
Mortgage Leader:
Address:
Architect/Engineer:
Address:
Phone:
Fax:
Application is hereby made to obtain it 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 rcquirenicpts,of Florida LiTL_aw, S 713.
Signature of Owner/Agent Date Signature of ;mitt ctur/Agent Date
_ _ 7ccam..
Print Owner/Agent's Name _ Prin Cotltrt ;tctor/Agent's NNan e
%!'-lI L al /7, l L cru
Signature of Notary -State of Florida Date Sianatur�f No
Owner/Agent is __ Personally Known to Me or Cuntraclur/Afent is.
__ Produced ID � _ 1'roduccd lU_
APPLICATION APPROVED BY: Bldg: Zoning: J Utilities:
(Initi I & Date) (Initial & Dale)
Special Conditions:
Florida
Comm# 000291408
&n . Expires 2/10/2008
:;h`� Bonded thru (800)432-4254!
I Kuowi o Mc; r iOFF�d�; Florida Notary Ann.. Inc
num��
(Initial & Date) (Initial &, ate)
"§ 10 90,`3
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'NOTICE: This drawing and the data thereon shall not be duplicated, used, or disclosed to others for -
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I permission of SimplexGrinneh. Al reproductions shall bear this notice.
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