HomeMy WebLinkAbout304 Rochelle AveCITY OF SANFORD PERMIT APPLICATION
Permit # : " / J Date: /C,/3%
Job Address: PL-11 PCCktM4Lw_ AJEWIGi BUl1.d1 Re 3
Description of Work: RE' S
Historic District: 140
T Total Square Footage
Zoning: Value of Work: S 301 ODy
Permit Type: Building X 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
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
Industrial
Plumbing Repair — Residential or Commercial
Construction Type: LWO # of Stories: 3 # of Dwelling Units: 7A Flood Zone: _gj k (FEMA form required)
Owners Name & Address: V1` I;TGP VC)MINte
Contractor Name & Address: #Jt H IAV% 1
III (%Vft, G,trCek G -e
Phone & Fax: 0 • 7 7 • 5 1
Bonding Compaoy: t4l .
Z3?+1 1 Phone:
State License Nuumber:/ «1C. 7 1'Z•
Phone: 4-07• 345,5lei
Address: WIX
Mortgage Leader. 14
Address:
Archilect/Engineer: N Phone:
Address: NIp. Fax: 1414
Application is hereby made to obtain a permit to do the work and installations as indicated. l 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 w anagemeni districts, state agencies, or federal agencies.
Acceptance of perm is v'ficati n that I wiilI notify the owner of the property of the require me of rida w, FS 713.
Signature of Owner/Agent Date Signatur of Co actor/ gent +Dj
6t+OrrL&9S L - 6AK141a )k • f
Print Owner/Agent's Name Pr ontractor/Agent's N tre
9
Signature of Notary -State ot'Plaride- Date Signature of Notary -State of Florida • 5 SC A R(ql '•r
T.tRS •.t• •`d;t i,ligyk* Off;
IRENE FUENTES
Notary Public, State of Texas
Owner/Agent is _Personally Kno ,•,, Y Commission EXISMttrac Agent is Personally wn to 11194 "sti rd
Produced ID 'pa" a•" February 17, 2010 ro ced iD ' / t C • A eo
oe TM 1'Fa/ nsura•'
APPROVALS: ZONING: UTIL: FU: ENG: BLDG: ei. $1Ai.as••••
Special Conditions:
Rev 03/2006