HomeMy WebLinkAbout1703 W 3 St00CITY
OF SANFORD PERMIT APPLICATION
Permit # : —I I ••,, Date:
Job Address: MA co3 JT.
Description of Work: .iS,A Y- MC_ f JilrAZi i Total Square Footage 02
Historic
District: Zoning: Value of Work: S 7'7" r
Permit
Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical:
New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole _ Mechanical:
Residential f/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 Construction
Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required) Owners
Name & Address: _ w Ay rt I-rAI 0-n zisr— /I - 3o — _5,9 If - o 510 - 00 wo Contractor
Name & Address: BARNES HEATING & AIR
CONDITI NI 91
tee own NT Phone &
Fax: SANFM. Ft 32171 Bonding
Company: eon 1 Address:
Mortgage
Lender: Address:
Architect/
Engineer: Address:
Phone: (
k2 - State
License Number: !^/tiCa 3(aW--V Contact
Person: tan I •E Phone: Phone:
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. 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 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 management districts, state agencies, or federal agencies. Acceptance
of permit is verification that 1 will notify the owner of the property of the require nts of Florida ie aw,aZ3,g Signature
of Owner/Agent Date rgnature of Contractor/Agent Date Print
Owner/Agent's Name Signature
of Notary -State of Florida Date Signature Owner/
Agent is _ Personally Known to Me or Contractor/AgeW Produced
ID Produced ID APPROVALS:
ZONING: Special
Conditions: Rev
032006 UTIL:
FD: Name
DEBBIE
BLANTON W
COMMISSION # DO 18MI EXPIRES:
February 25, 2W7 ENG: -
BLDG: 1
53