HomeMy WebLinkAbout1616 E 4 St (5)rmit q : O f7- (V/
b Address:
scription of Work://rO C S'Sy
istoric District: Zon
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CITY OF SANFORD PERMIT APPLICATION
Date: .. — /-Ol!",
oral Squ re Footage
0,
Value of Work: $
wmit Type: Building Electrical Mechanical t/ Plumbing Fire Sprinkler/Alartu Pool
ectrical: New Service - H of AMPS Addilion/Alteration Change of Service Temporary Pole _
eehanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
umbing/ New Commercial: k of Fixtures H of Water & Sewer Lines q of Gas Lines
umbing/New Residential: M of Water oscts Plumbing Repair - Residential or Commercial
mapancy Type: Residential Commercial Industrial
instruction Type: q of stories: N of Dwelling Units: Flood Zone: (FEM A form required)
voers Name & Address:
Phone: yr// " J d 7 f2L:P1 _
ntractor Name &Address: f/BGP /C/Lr15 A Os _
9-44 Oae State License Number: CRe Oyy% 7,
one & Fax: Contact Person: f{p( Affn40S Phone: nding
Compaoy: dress:
rtgage
Lender: dress:
chitecl/
Fagiacer: dress:
Phone.
Fa
a: plication
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 Dance
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 mit
must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS. POOLS, FURNACES, BOILERS. HEATERS. TANKS, and t
CONDITIONERS, etc. NER'
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 rstnrdion
and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING NICE
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN TORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. TICE:
In addition to Umc requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of county,
and these may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. eptance
of permit is verification that 1 will notify the owner of the property of the requirements of Flqdda Lien Law, FS 713. Signature
of Owner/Agent Date Sign ie of Contractor/ gent Dale Print
Owner/Agent's Name Printq;
zz Name Signature
of Notary -State of Florida Date Sig r Date DEBBIE
BLANTON MY
COMMISSION p DD ISS461 EXPIRES:
February 25, 2007 Owner/
Agent is _ Personally Known to Me or Contract r/ QR' Pc(§6 0yyRYmmnaAeddmor Produced
ID Produ „' ROVALS:
ZONING: UTIL: FD: ENG: BLDG: cial
Conditions: 03/
2006 d 53
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