HomeMy WebLinkAbout310 Rachelle Ave (3)CITY OFSANFORD PERMIT APPLICATION
ermit # . 0 1 ^ ! ` Date:
lob Address: 3 10 R6( r VAJ, ACE- BU I LDS tJ G -4 %
escription of Work: 1ty r SIDE * Rs- PPANT Total Square Footage
fistoric District: tic) zoning: &A%VRhr& Value of Work: S 3 S 0 0
ermit Type: Building X Electrical
3lectrical: New Service - # of AMPS
Mechanical: Residential Non -Residential _
lumbing/ New Commercial: # of Fixtures
lumbing/New Residential: # of Water Closets _
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
Plumbing Repair - Residential or Commercial
ccupancy Type: Residential k Commercial Industrial
7onstructioa Type: LA00A # of Stories: 3 # of Dweuing Units: Z Flood Zone: t,10 (FEINA form required)
Name & Address.
ontractor Name & Address:
111 6644N C C41:
hone & Fax: T" t
londing Company: 13
Z321'1 Phone:
I R !Wll State License Nomber C GG (S l l? 4 Z-
CoataetPerson: 'hM 41)ORgy Phone: 4o7.3b5.51b,
ddress:
dortgage Leader r
ddrew:
rcbitect/Enoneer. Pbooc:
ddress: Fax:
pplication is hereby made to obtain a permit to do the wart and installations as indicated. 1 certify that no wart or installation has commenced prior to the
stance of a permit and that all wort will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand drat a separate
ermit mist be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES. BOILERS. HEATERS. TANKS, and
IR CONDITIONERS. etc.
WNER'S AFFIDAVIT: 1 certify that all of the fongoing information is accurate and flit all work will be done in compliance with all applicable laws regulating
onstruction and mnQrg WARNING TO OWNER YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
VICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
I FORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT
1 : In additiaa to the re uiranarts of this permit, there may be additional manctions applicable to property that may be found is die public records of
its county, and tlrere may be additional permits required bom other gvertrme ntal eatities such as t districts, state ag corm s, or federal ageacies.
cceptancc of permit " verification That 1 will yn o ify the owner of the property of the requi of Fl 'da L' Law, FS 713.
1 M, 40G "b 9•z9.OL / z 0
Signature of Owner/Agrort Date Signature of Con or/Abort Date
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Print Owner/Agau's Name
a k!Aq ,' , S'-zS-oy
Sigraaae of Notary -State ofPlerWa --" Date
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ffmcn"ft w'i
ontractomr/Agent's t amc
of Notary- of Moridi Date) - - v
IRENE FUENTES
OwnedAgent is p.M y = • Notary Public, State of Texaco / erp is _ P 1 K-
22MyCommissionExpiresAgywrlY
Produced ID '' February 17, 2010
oduuxd ID
PPROVALS: TONING: UTIL: FD. ACO
Nolary ubli0,l31dre r r:da
perms
3/20061W My Comm, expirr;s Juiy 2. 2U0