HomeMy WebLinkAbout300 Rochelle Ave1 l
C:ITV OFSANFORD PERMIT APPLICATION `
Permit # : ( C ( Date:
Job Address: AVP-i--JVg soI (,CK460 0
Description of Work: SIDE 'C RFE- FAVT Total Square Footage
Historic District: Zoning: E9(k*nl1r& Value of Work: S 501 ow
Permit Type: Building _X 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 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 k Commercial Industrial
Construction Type: WOO # of Stories: Z' # of Dwelling Units:
II
10 Flood Zone: _ (FEMA form required)
Owaers Name & Address: ry
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Contractor Name & Address: O wG[ C * ni LOC ,
111 6144 , GrelC ((YtAc W1`Aivv *,&)V t 3Z7
Phone & Far. 07. 3• ( Contact Person:
Bonding Company: o JAL
Phone:
State License Number. 56K (5 1 74 Z
Im -tboRroy Phone: 407-145.511•tt'
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. 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 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 management districts, state agencies, or federal agencies.
Acceptance ofj'r ven cation at willynotify the owner of the property of the require is o lorid ten Law, FS 713.
7wi 9 -9•o6 v
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owls Name Contractor/Ag is Name po" SC AR(,Q °°i
9-29-04
Signature of Notary -State orf'briiia Date Signature of N
Te-1K
IRENE FUENTES
s Notary Public, State of Texas
Owner/Agent is r Personally Kno My Commission ExpiLeantra r/A e
Produced ID February 17, 2010 p uced
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
UTIL: FD:
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