HomeMy WebLinkAbout2416 Palmetto Ave (2)CITY OF SANFORD PERMIT APPLICATION
Permit # : % ' CJ1
Date: /0-11 O b
Job Address:
Description of Work: Re w iMe KeougmW ocy Way-4 t7ag- Historic
District: _/p Zoning: Value of Work: S Z350.sPermit
Type: Building Electrical htfL-Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical:
New Service — # of AMPS Addition/Alteration Change of Service 60L Temporary Pole Wj 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 Description) Owners
Name & Address: ERe d M W ll<NO We S/
cif'Y! - Phone: Contractor
Name & ,address: !/1A/Oy-r144AC77-rca State
License Number: 6 /300 /94t3 hone ,.
k Fax: ] - 32 2- CJ e Z Contact Person:/ y ?hone: sIA-IC 3onding
Company: t-1 iddrebs:
Mortgage
Lender: Wdress:
rcnmecv'
i;;_ neer: ourcas:
tone:
made
w ,u..... _ .. _rnn : :u ;ne c,,,... . ;a ;..,;ailauo::_ .., ;nuicc. .. ^.: ; v:r,r :.•r :- a:iau,:;. .... .r.m-cnr.., , ;r 7.1: ssuancu -
erma ::nd trat ctt • art: •.: ui ;:e per:ormed :.; :neer stanaaras c; ..;;laws m;urrn construe: on in :.;is junsaicr;on. ... nuer:tano rtui _ _epurcte permir
must ce secnrea for ELECTRICAL VORK. ?LL;IvIB[NG. _"IGNS, bVELLS, POOLS. FJRNAC"a5. 301LSRS.:HEATERS.-AtNKS. una MR
CDNDITIONERS, 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 PAYIW TWICEFORIMPROVEMENTSTOYOURPROPERTY. 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 req ' ats of Florida Lien Law, FS 713 Signature
of Owner/Agent Date r turc of Contractor/Agent Date Print
Owner/Agent's Name Signature
of Notary -State of Florida Owner/
Agent . Personally Known to Me or Produced
ID APPLICATION
APPROVED BY: Bldg: Initial &
Date) Special
Conditions: Date
Print
Co for/Agent's Name turcofNotary-
StateofFlorida a"'-,, Lori Willick Commission #
DD369931 Expires:
S08, 2008 Contractor/Agent
is Personally Known to NiEgP!,F; BondedThru Produced ID Atlantic
Borttiirtg Co., Inc. Zoning: Initial & Date)
Utilities:
Initial & Date)
FD:
Initial & Date)