HomeMy WebLinkAbout1114 W 8 StPermit # :(
lob Address:
CITY OF SANFORD PERMIT APPLICATION
1 S Date: CJ 3 O ti
Description of Work:
Historic District:
cSz'`% O TTelal Square Footage
Zoning: Value of Work: 00, ed
Permit Type: Building Electrical hanical Plumbing Fire Sprinkler/Alarm __ Pool
Electrical: New Service -# of AMPS t 6 0 l Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duc( Layout & Energy Ca1c. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines —_
Plumbing/New Residential. # of Water Closets Plumbing Repair - Residential or Commercial _
Decupancy Type: Residential ---commercial Industrial
r1onstruction Type: N of Stories: # of Dwelling Units: Flood -Zone: (FEMA form required)
3•waers Name & Address:
contractor Name & Address: F4'a V,
CTo
Phone:
License
hone & Far:'eaz crzf— O D Contact Person: _ AILLES Phone:
3onding Cempaoy: Y t Lf y-/ /Q N `'
t/ r— e e_ lly
ddress:
Qortgage Lender.
ddress:
rchilect/Engineer: Phone:
ddress: Fax:
pplica(ion 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
oemnit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, HOILERS, HEATERS, TANKS, and
UR CONDITIONERS, etc.
WNER'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
onstruction and zoning. WARNING TO OWNER- YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMFNT MAY RESULT IN YOUR PAYING
WICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
TTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
40TICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that maybe found in the public records of
his county, and them may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
cceptance of permit is verification that I will ratify the owner of the property of the requirem rich l \\\I\\\`G11,T T
Signature of Ownerr/Agent Date at ure of Contractor gent`
Print Owner/A ent's Nameg Print Contractor/Agent's NardX • ; #f•
r GSJr2ga • *
Si gn Notary -StateSignatureofNState of Florida Date g Notary -State of Flo / •
G"
Signature of Not Q0%
Owner/Agent is _ Personally Known to Me or Contractor/Agent is Personally Known to Me or
ct- 57- 1 S- 6ProducedIDProducedIDTELo3(0-- i
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APPROVALS: ZONING: UTIL: FD: ENG: BLOC:
pecial Conditions:
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