HomeMy WebLinkAbout2421 Laurel AveJ
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CITY OF SANFORD PERMIT APPLICATION
Permit # : (
r 0 7 Date: / /% /o l
qZ l 0 t A''Job ddresr. Q
e%DesCr1'tun of Work: Total:$ e ootag
Historic District: Zoning: Value o Work: $ ?./00
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # :zommercial
Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Industrial
Construction Type: _ # of Stories: / # of Dwelling Units: Nd Flood Zone: (FEMA form required)
Owners Name & Address:
2 2 1Z Phone:
Contractor Name & Address: CIN'l_tVCroV94 f, NC 1A4VL S Mkt?
Phone & Fax:
Bonding Company:
Address: c
Mortgage Lender:
Address:
Architecr/Engincer:
Address:
C....., r o..... ni.....ti..... l—l—l_ C
Phone:
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 ofa 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 NOTIC50F COMMENCEMENT.
N TI :In addition to the requirements of this permit, there maybe additional restrictions applicable to
this county, and there may be additional permits required from other governmental entities sue c
Ace ranee of pe 't is verification that 1 will tify the owner of the property?
ignature of Owner/Agent Date
APPROVALS: ZONING:
Special Conditions:
Rev 03/
2006vo-z
Date
Bttttd-by MIXIM04%
UTIL: FD:
iuirements of
ature of
Prim Contras
Signatu
I. 1
th rppe@i o found in the public records of t
nanagemem districts, ag ics, or federal agencies.
13.
ntractor/ c
W
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ANIAN Rate
t;,ontmfl ppoa3317:
Bonded by law 33-234
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ENG: BLDG:
a-f7.00
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: A.
3gi o{ L A kt:3 SvcoR-
W- r (--I 37?T
License #: 4f' CC -' OS-2 35-:7
Project Information
Owner: Pin') H e2:r= a y- Permit #:
name
7_4 Z I L4,o E / A Sµv a0 Subdivision:
address
35-7- Vr3 76(3 Lot M
phone
affjant, hereby affirm that I am the duly licensed
contractor of record for the above referenced permit, that all the foregoing information is true
and accurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accordance with the applicable codes and standards.
Contract —+
signature
printed name
STATE OF FLORIDA
COUNTY OF 5?AA u61t
This instrument was acknowledged before me this 39, day of OLiMber , L2O L, by the
above referenced individual, who acknowledged that he/she is a
duly licensed contractor with , and who acknowledged that
he/she was authorized to execute this document. e/she is either personally known to pi"111ll/pjm
produced '1.1 U Zoo -1684'ivy.--'4-f 1-0 as valid identification. \P.NNETr /,
WITNESS my hand and seal this 39_ day of
uay
SS'o2• t
Nota Public CY
OF F