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HomeMy WebLinkAbout222 Towne Center Cir (2)CITY OF SANFORD PERMIT APPLICATION Permit #: ou - ( Date: 1 V ' l)' ©U Job Address: _ C) Description of Work: Total Square Footage Historic District: Zoning: Value of Work: S ')t i • eo Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service — # of AMPS Addition/AIteration Change of Service Temporary Pole Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: # of Fixtures _3 # 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) a Owners Name & Address: Phone: Contractor Name &Address:/aYSo-r-y7Ji y r75isvt 10C2 /XLP--*1S0 W W ( tiL_ P 3 L I?0'7 State License Number: e T C.0 S% V 7 y Phone & Fax: % Z. iil'GSZlS 07 3 Contact Person: 070 lk I TAd Le Phone: '1107— v07.F830 Bonding Company: 3 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. 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 maybe additional restrictions applicable to this properly 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. is verification *at 1 w)tlllotify the owner of the property of the requirements of Florida Lien Law; FS 713. Co Owner/Agent is _ Personally Known to Me or Produced ID APPROVALS: ZONING: UTIL: Special Conditions: Rev 03/2006 Date Signature of Contractor/Agent Date Print Contractor/Agent's Name Date Signature of Notary -State of Florida Date Contractor/Agent is _ Personally Known to Me or Produced ID FD: ENG: BLDG: