HomeMy WebLinkAbout101 Hazel BlvdCITY OF SANFORD PERMIT APPLICATION
Permit N :y 0GX-i / Date:
lob Address: lbl µAZ & ( BLO D , S F-O \ 6 C-L 3 z717 3
Description of Work: V---P4 hAg Total Square Footage
Historic District: Zoning: Value of \York: S Z-:00co
Permit Type: Building 131ectrical Mechanical Plumbing X-- Fire Sprinkler/Alarm Pool
Electrical: New Service - A of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: k of Fixtures q of Water & Sewer Lines N of Gas Lit
Plumbing/New Residential: q of Water Closets Plumbing Repa' - Residential or Commercial
Dccupancy Type: Residential —X— Commercial Industrial
Construction Type: ' N of Stories: H of Dwelling Units: Flood Zone: (FEMA form required)
7waers Name & Address: (,N i. S U 1 Ta& I A9K a,-:4U.t N(ca to I I4I9 Ze2 (eta! D r1 3 Z77 3
Phone: `101 - Z-7-i - Z33Z
contractor Name & Address: a - 7d2
Mt O.._- kblAcstrtrCa n!c State License Number: CkCD 3-7 I2q
hone& FaxtiDl-5r7S-111io LjO7-291-39yy Contact Person: Mwe-PA-q- A00J4oft 1 , Phone: L11D1- ylv16-Q&6`
3onding Company:
ddress:
1lortgage Leader:
ddress:
rchilect/Engineer:
ddress:
Phone:
Fax:
pplication 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
ssuance of a permit and dial all work will be performed to meet standards of all laws regulating construction in this jurisdiction. 1 understand that a separate
Permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
UR CONDITIONERS, ctc.
WNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done inIcompliance with all applicable laws regulating
onstruction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
WILE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND 1*0OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
1TTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
MCE: In addition to the requirements of this permit, there may be additional restrictions applicable
his county, and there may be additional permits required from other governmental entities such as wo6
cceptance 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 -Stale of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
PROVALS: ZONING: UTIL:
pecial Conditions.
cv 03/2006
FD:
in the public records of
Gcs, or federal agencies.
l/" o•2S-rJ6
ign ure 6fContractor/Agent Date
P tg0fARen01Namc
j MY COMMISSION # DD tggggt
f €%(M S: Fobnsry 25. 2007
143003NNARY S. Y DL blunt As=& C,.
Contractor/Agent is _ Personally Known to Me or
Produced ID
ENG: BLDG:
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CITI' OF SANFORD PERMIT APPLICATION
Permit a : Date: )o -)1,-D(-p
lob Address: J 01 µAZEL• Q ujt - SA.,k,,g.t L . - 2T73
Description of Work: W r e:P)PC 'total Square Footage
Historic District: "zoning: Value of Work. $ I?",
ev
Permit Type: Building Electrical
Electrical: New Service - q of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Dccupancy Type: Residential Commercial
Construction Type: N of Stories
3woers Name &
0 1 1-_ n
Mechanical Plumbing X Fire Sprinkler/Alarm Pool
Additiort/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
P rjbZE Z
Flood Lone: (FF.AIA form required
Phone: M%- ZZI -2332_ -C
contractor Name & Address: Pr- l Lt3 I. C!?- FYf c r 6 1 A) C_
2-e-0 1 Pr3v jayclbA1 5r/L P PoPk.A a 3wstateLicense Number: hone &
Fax:tJQ1-S7?-_)Fy0 qy7 Z47 ?Vy Contact Person: Vo h 7(1 S 3ouding
Company: ddress:
lortgagc
Lender. ddress:
rchitectfFrigineer:
ddress:
Phone.
Fax:
pplication
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 ssuance
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 Kmtit
must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, IIEATERS, TANKS, and UR
CONDITIONERS, etc. WNER'
S AFFIDAVIT: I certify that all of the foregoing information is accurate and dw all work will be done in compliance with all applicable laws regulating vnstruction
and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING WICE
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITII YOUR LENDER OR AN TTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. tOTICE:
In addition b the requirements of This permit, there may be additional restrictions applicablet this prFythal,—_, f din the public records of his county,
and dwm may be additional permits required from other governmental entities such as w m tdtc agencies, or federal agencies. cceplance of
permit is verification that 1 will notify the owner of the property of the requir me of F a n A/ 16 -6t6
Signature of
Owner/Agent Date lsikfiaturlof Contra for/Agent Date e/L/ "
I Put A.n_d=7,3a/s 7A -,V o Print Owner/
Agent's Name Signature of
Notary -State of Florida Date Owner/Agent
is _ Personally Known to Me or Produced ID
d'PROVALS:
ZONING: UTIL: pecial Conditions:
ev 03R006
of I
Name
DEBBIE BLANTON
MY COMMISSION #
DD 1 SMI EXPIRES: February
25, 2007 NO.3•
NOTARY FL Norory Contractor/Ag ^-
Persewally.Km,* Produced ID
FD: ENG:
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