HomeMy WebLinkAbout2005 S Magnolia Ave (3)d b - z-o If/
1 Q
CITY OF SANFORD PERMIT APPLICATION
Permit # : n6 282' •
Date: 7 -19 A&
Job Address: ?.W s' /%JjO jy j p { dAC
Description of Work: r,09900/Y?/ 56arcr-- Historic
District: n(D Zoning: - Value of Work: S /—W. ef, Permit
Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical:
New Service - # of AMPS Addition/Alteration Change of Service -t--lTemporary 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 #:
Attach
Proof of Ownership & Legal Descri tion) Owners
Name & Address: /A,,
r
Phone: /
Tom/ •- <(s (a-reo Z, Contractor
Name &address: L G 'S i•D i.. // hone
s Fax: 3onding
Company: vddress;
Aortgage
Lender: Address:
rcnnccrri::
c:nerr: aar
as: Contact
Person: State
License :-Number: hone:
hone:
i-3 —/2, uc::
a, r. -. .Iadc u:.,.. -;: 7y 7 ...., o-or;: ..r ,raiiaco:: .,... .r.nt:a• n :^, . ,.;r ; ssuance
ur a -erm::::nd ma[ all • on:'.:ni ;e pe.:brrned :nee[ staneards :I laws rz;uiarr. ' Dnstruc::un in : Js junsaic:;ur,. ...auer:::anu t :a; _ caoar.:[a perma
must oe secnrco for ELFCTRIC.IU L VORK. LIBfNG.:;:JIGNS,'FLLS, POOLS, URNAC=S. 301LERS. aEATERS. -ANKS, mo AIR CONDITIONERS, atc.
y 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 PAYrM TWICE FOR IMPROVEMENTSTOYOURPROPERTY. 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, then: 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 I will notify the owner of the property of the requireme s of Florida Lien Law, FS 7 Signature of Owner/
Agent Date Si re of Contra for/Agent p A ..\\wlIIhI 'l,_
Print Owner/Agent'
s Name Signature of Notary -
State of Florida Owner/Agent is _
Personally Known to Me or Produced ID APPLICATION
APPROVED BY:
Bldg: Initial & Date) Special
Conditions: Print
DateSig—nature
of
Notary -State Q": GpMMiSSrV Q
j 1 /F • Oland . Date H , -
4 Contractor/Agent is _
Personfta- tq wQQ'; a e, ProducedID — Q
C- Zoning: Utilities: FD:
Initial & Date) (Initial &
Date) (initial & Date) 4 ,s,00