HomeMy WebLinkAbout700 Laurel AveCITY OF SANFORD PERMIT APPLICATION
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Permit #: V
Q1 (aQ Date: 7 L/O(i
Job Address: 700 4o"ACG olove
Description of Work: EIfA(7e4e9L CODE W *1" E Total Square Footage
Historic District: Zoning: Value of Work: S Zoo • VP
Permit Type: Building Electrical 9 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: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
Owners Name & Address: M )" A i t. D OZOTH Y In1 E4J
20, IL 5Xj~,E R 13/V*Kc LW GMs1gL_0if m4y 32707 Phone: 407 L 19T f354
Contractor Name & Address:
PORD,c tJODS El, M ?f State License Number: kt 000 1 S-C4
Phone & Fax. C7 D b'3 Contact Person: Eu Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engincer:
Address:
Phone:
Fax:
Application i
of
hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuancef a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separatc
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 districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
1AAL.lo4-
4bswL 4 / i L 6b Signature
of Owner/Agent Date Signature of Contractor/Agent ate Print
Owner/Agent's Name Signature
of Notary -State of Florida Date Owner/
Agent is _ Personally Known to Me or Produced
ID APPROVALS:
ZONING: Special
Conditions: Rev
03/2006 EPWAas }
how avv)k t P '
ntractor/ nt's Name Si
Date DEBBIE
BLANTON MY
COMMISSION # DO 188491 EXPIPES:
February 25, 2007 CLr
6hr is Ft. Persdiiaily+12+>r Cto a or ed
UTIL:
FD: ENG: BLDG: