HomeMy WebLinkAbout136 Augustus PointrNbe- 7ow '. RECEIVED
CITY OF S-A-NFFO-RD PERMIT APPLICATION
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J u L rl1K"j--L{-- Date: _
Job Address: --
Description of W
Historic District:
NOV 1 U 2006
Permit Type: Building L r Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool I I,Uti l
I UtGi(L
Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole
d0
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
PIumbing/New Residential: # of Water Closets
Occupancy Type: Residential __ Commercial
Replacement New (Duct Layout & Energy Calc. Required)
of Water & Sewer Lines # of Gas Lines
Plumbing Repair - Residential or Commercial
Industrial Total Square Footage:
Construction Type: Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: (% _(7'' 3 I - DU -O (1 " d (Attach Proof of Ownership & Legal Description)
Owners Name & Address: E \NiE3T' L •l. • C I O I $t j P4 t-i.sFc L r•• ST£ 2-t,o
Aft 2 3Z?Sl _Phone: ---
Contractor Name & Address: •?. 76
State License Number:
Phone & Fax: — Zyd ry j Contact Person: e t -J1 Phone: 2/
I
EJ ZJ UL 2
Bonding Company: _,I!S. —
Address:
Mortgage Lender:
Address:
ArchitecU-miner eeT. r
f'
C Tif,/(C l/tt e_Phone:
Address: Cj 7G FSFax: --
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 pennit 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 regulanng
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESI't.T IN YOUR PAYING
T%VICE 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 pennit, 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 managemer}{,, state agencies, or federal agencies
Acceptat per it is nficati t ill tify the owner of th pro rty of the requirements of ' ten Law, F
Signature of Owner/Agent ate Signature ofContn r/ a Date
CrO l ta Saar t o cL s
Pri t O; ner/ gent's me P ' t ontractor/Agent's N
A me
Sign ture.of Notary-StatF of Florida .•.++++..+++,+++,,.,,D+•,. Sign re of Notary -State of Flor da —
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Owner/Agent is Pe
Produced ID
APPLICATION APPROVED BY: Bldg:
Special Conditions:
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