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CITY OF SANFORD PERMIT APPLICATION
C/ Permit #: V O0O! Date:/
Job Address: 4,0 &/? a S A L 1 YQ b e,
Description of Work: RCP L Qn-g- Gi4IQg6 E J)0O Total Square Footage Historic
District Zoning: 3 Z%7 `2 1 Value of Work: Ste, Z'2 A-M) Permit
Type: Building Electrical Mechanical 'A Plumbing Fire Sprinkler/Alarm Pool Electrical:
New Service — # of AMPS Addition/Alteration Change of Service 'fetnporary Pole Mechanical:
Residential /X Non -Residential Replacement _ New (Duct Layout & Lnergy 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 Dccupancy
Type: Residential >< Commercial Industrial Construction
Type: I_ _ # of Stories: # of Dwelling Units: Flood Zone: (Fk:MA form required Jwaers
Name & Address: t` 2 C 14 1A /V C i 0 U a 4/.
06 1Z0-100,LI4 1242, !j0"C— 2D Phone. 417`I -j, t-i-cj 3 contractor
Name & Address: LOLL C.= 5 /D&4 C 7—FII a 1 C State
License Number: hone &
Fax. Contact Person: Phone: 3onding
Company: tddress:
Mortgage
Leader: ddress:
rehilect/
Engineer: Phone. ddress:
Fax: pplication
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 ssuance
of a permit and drat all work will be performed to meet standards of all laws regulating construction in this jurisdiction. 1 understand that a separate Hermit
must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, BEATERS, TANKS, and 1R
CONDITIONERS, etc. WNER'
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 moruction
and zoning. WARNING TO OWNER. YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MA Y RESULT IN YOUR PAYING WICE
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN TTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 40TICE:
In addition to the requirements of this permit, there may additional restrictions applicable to this property that may be found in the public records of his
county, and there may be additional permits required 6om other governmental entities such as water management districts, state agencies, or federal agencies. ccep
of t is vuif at 1 will notify the owner of the property of the requirements of Florida Licn Law, FS 713. loozol,
Signature
of /Agent Date Signature of Contractor/Agent gc-
aci M,g E. i2o E Print
OwneOAeent's Name Date
NY
COMMISSION # DD 1SMI L,.
EXPIRES: February 25, 2tX17 n^
tx-S-NOTARY Ft. NW-y ta-MO Aram. Co. Owner/
AgenI is _ Personally Known to Me or Produced
ID LPPROVALS:
ZONING: UTIL. pecial
Conditions: cv
03/2006 FD:
Print
Contractor/Agent's Name Signature
of Notary -State of Florida Date
Date
Contractor/
Agent is _ Personally Known to Me or Produced
ID ENG:
BLDG: _* f3