HomeMy WebLinkAbout1516 Palmetto AveCITY OF SANFORD PERMIT APPLICATION
Permit #
Job Address:
Description of Work: Fu
Historic District:
Permit Type: Building Electrical Mechanical Plumbing, Fire Sprinkler/Alarm 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 Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: a 9—+ - s- 67 - /70 3 0 (Attach Proof of Ownership & Legal Description)
Owners Name &lA ddr/ess: J u C hrls' n Ck i a-
to . I C.! n 7LAve Y -FL 3 a —7 I Phone:
Contractor Name & Address: 62S
1
1 {- le'l C S ZI? C
157 S - '_P-a,1 Are 103 P CA, FL 3a-M,3 State License umber: -79
Phone &Fax: -77 — a 3 - i%S' / i Contact Person: r 0'r 1 Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
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 permit and that 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
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 mans ement districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirement f Flo L' n Law, FS 713.
Signature of Owner/Agent Date Signature of Cont or/Agent Date
V pcen-t- 6) 1 ZZi
Print Owner/Agent's Name Print Contractor/Agent's Name
Signature of Notary -State of Florida Date Signature of Notary-Stat f FI
dWm
p CHELE A. VWATSKY
sfNlotory PubOc - State of Floridc.-"
CMVr"0nS0es,AM24,2WRiCommisslon#DD33)967
Owner/Agent is _ Personally Known to Me or Contractor/Agent is PersO Ily9 rio ByNAGllonol Notary' Assr•
r
Produced ID
i*J1cc _Produced ID
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
Initial Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
has
PERMIT
AUTHORIZATION
Vincent Polizzi_hereby authorize
License Holder)
to obtain a gasplumbing permitgP
Authorized Person)
in my.behalf under my license # CFC057948
for the job described below
DESCRIPTION
OwnerJT-nni.(e.1-+- C/sr,A,6 gee ei n a-n
Site Address J6/(v Sint '4/(f-
Tax Parcel #.-Ay3 - 6-46 - /70a-
License Holder signature)
Date_ LIW 1Ol
State of Florida
County of \I011UJ1 Vk
Affirmed and subscribed before me this 1-" day o(Dc ZOINP by jig 1 ui1 Who is
p sonally h— to me or has produced (type of f.D) as identification na Signature
of
Notary Public, State of Florida Print, Type or Stamp Name of Notary CHRI MM
EC 1011 Hoar Pdit-
Oft of Floes. ApComN1110e 28`
Notaries Seal
m10 Conrellm
M.
00 MDMN MowBMWIm NwonMNOW
A
Gas Plumbing Services, Inc.
1377 S. Leavitt Av.:. Suite# 103 Orange City, FL. 32763Office: (386) 774r-8244 Fax: (386) 775-1749 State License# CF-0057948 LP# 408-17000
Date: 11-3o - cC.
PERMIT NO:
BUILDER:
ADDRESS:
MODEL:
GAS TYPE:
DELIVERY PRESSURE:
PIPE TYPE: CSST/GALVANIZED
LONGEST RUN:,
FURNACE:
RANGE: 1 0
WATER HEATER: I
DRYER:
FIREPLACE: 14o
GRILL: T-o
SPA/POOL HEATER
OTHER:
TOTAL LOAD: 3 3 9 k
SIZING TABLE USED: % /—q
Created by.
Vj( H.11
4.
PLANS REVIEWED
CITY OF SANFORD
OFFICE
tRMIT