HomeMy WebLinkAbout200 Persimmon Aver
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CITV OF SANFORD PERMIT APPLICATION
Permit #:- O Date: e.*s$ — QAo
Job Address: kW Agee S1`h_ot 4,4 t — a'a`O? ` W 04 S+- !,V"
Description of Work: OlrwA m Sf14cIL etal Square Footage
Historic District: Zoning: Value of Work: S'
Permit Type: Building Electrical
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures _
Plumbing/New Residential: # of Water Closets _
Mechanical Plumbing -df Fire Sprinkler/Alarm Pool _
Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. Required)
of Water & Sewer Lines_ # of Gas Lines
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: S,.A.4
1 \\
Phone:
Contractor+ Name & Address: _ fsg lV D+1% y+1C %0 S J A k4t
SO`^rrd f l 3.1711 State License Number. FGOS'7a?i
Phone & Fax: 40-7 bm XLX-4 Contact Person: Phone:
Bonding Company:
Address:
Mortgage Leader.
Address:
Architect/Engiaeer: 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 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: 1 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 ater management districts, state agencies, or federal agencies.
Acceptance of permit is verification that 1 will notify the owner of the property of the requiremints ofV*Wd a X&ff b1p-T"3.
Signature of Owner/Agent Date
Print Owner/Agent's Name Print
0% - Os.
Date
Signature of Notary -State of Florida Date Signature a of Florida Date
DEBBIE BLANTON
MY COMMISSION # DD ISM1
EXPIRES: February 25, 20w
Owner/Agent is _ Personally Known to Me or Contrac /Agoopiso'kRY Pers9ir0J*fbKbWMt &@b
Produced ID _ Pr
APPROVALS: ZONING: UTIL. _ _ FD: ENG: BLDG:
Special Conditions:
Rev 03/2006
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