HomeMy WebLinkAbout1204 W 20 St (3)Permit # : Cam- QKS
Job Address:
Description of W
Historic District: Zoning-,
V
CITY OF SANFORD PERMIT APPLICATION
Date: _ y
Value of
Total Square Footage
S /Ze 2tR .
Permit Type: Building Electrical Mechanical Plumbing V Fire Sprinkler/Alarni Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential, # of Wat Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial
Construction Type` # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required
Owners Name & Address:
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Leader:
Contact Person:
Number:
Address:
ArchitecVEsioneer. Phone.
Address: -- Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the
issuance of a permit and drat 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, IIEATERS, 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 COMMENCEMENTMAY RESULT IN YOUR PAYING TWICE
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT W ITII 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 thug may be additional permits required from other governmental entities such as water management districts, state agencies, or fcderal agencies. Acceptance
of permit is verification that 1 will notify the owner of the property of the requirements lori Lien Law, FS 713. Signature
of Owns/Agent Date nature ofContractor/Agent Date 406P Print
Owner/Agent's Name Print Contractor/Agent's N Signature
of NotaryState of Florida Dale S azure of,Qlot.q-State JOHNSIiP) Date MY
COMMISSION
f 00 28%22 EXPIRES: March
23, 2W8 rfa rT'
Bonded Thru Budget Notary Services Owner/Agent
is _ Personally Known to Me or Contractor/Agent is P rsall nown to Me or Produced ID I
Produced 11) Z • JV ' ZZ LJ APPROVALS: ZONING: Special
Conditions: Rev
03/2006
UTIL: FD: ENG:
BLDG: