HomeMy WebLinkAbout223 Justin Way (2)CITY OF SANFORD PERMIT APPLICATION
Permit # . b q.— 1-P `"'
1 Date:
JobAddress:c 3 N___3;AZ5TItJ WAi/ SAvJ btZDr L
Description of Work: 1' EPLAC.G E. <tST1tJC; =etA .e Total Square Footage
Historic District: Zoning:
Permit Type: Building Electrical
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Value of Work: $ t`2,0043
Mechanical Plumbing 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 _
Industrial
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
Owners Name & Address: A$Es I t2E' e M1 CHAEL LE.R Mc.1D£
PO 8C9" rnwzy . FL 327n-S Phone:
Contractor Name & Address:
Phone & Fax
Bonding Company:
Address:
Mortgage Lender:
Contact Person:
State License Number:
Address:
Architect/Engineer: Phone:
Address: Fax: _
ji-a-t- 833-86'A %
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 I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
Al 2 c D&
Sign reof0 gent Date Signature of Contractor/Agent
6Ylt C,-kaF, BcrZmuD%,z
Signature of No Florida"— "— "" "" --Date
MY COMMISSION # DD 188491
EXPIRES: February 25, 2007
1.800 NOTARY FL Notery Discount Assoc. Co.
Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
UTIL: FD:
Print Contractor/Agent's Name
Date
Signature of Notary -State of Florida Date
Contractor/Agent is _ Personally Known to Me or
Produced ID
ENG: BLDG:
BOUNDARYSURVEY
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Long Surveying, Inc Specializing
in Residenlia/ Surveying"
LB No. 7371 101
N. Country Club
Road, Suite 220 Lake Mary, FL 32746
Office 407-330-9717
or407-330-9716 Fax 407-330-9775
WWW. LONGSURVEY/NG.COM
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