HomeMy WebLinkAbout2605 Hartwell AvePermit #: n-1— 42
Job Address: 1.(pO5 ",-4L
Description of Work: CLPAC dH
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
I
Date: 10 / Q /0
Total Square Footage
Value of Work: S
Permit Type: Building ' Electrical Mechanical t.-I
Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of TAMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential t Non -Residential Replacement New Duct Layout & Energy Ca1c. 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
Construction Type: # of Stories: of Dwelling Units: Flood Zone: (FEMA form required )
Owners N am e&Address: bcna-4r(C r& j/ o1— 3/1 -'SDVe a20O .Z%O
X40 daz 2WK&e- ]i7 Ld- A/ 3A-272 Phone:
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
State License Number: kCZ 36 8.XY
Contact Person: &n 1 C Phone:
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 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: 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 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 dist fi%state agencies, or federal agencies.
Acceptance of permit is verification that 1 will notify the owner of the property of the requirements of Florida
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING: UTIL
Special Conditions:
Rev 0312006
Signature
Signature
Contractor/Agent is
Produced ID _
D0507298
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