HomeMy WebLinkAbout1006 S French AveCITY OF SANFORD PERMIT APPLICATION
Application # : � � Submittal Date: 0 10 l.v_y -7
Job Address: Y' SO(rh I�ienC►1 Aye��c Gn fora Value of Work: $ :goo00
Parcel ID:
Zoning:
Historic District:
Description of Work: Rpdab nq e l d rim) Square Footage:
•Permit Type: • Building 11• • • Electrical V(- Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
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
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑
# of Gas Lines
Plumbing Repair - Residential ❑ Commercial ❑
Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: - Flood Zone: (FEMA form required )
....................Y ....... (1...................................................................................
Property Owner: Adel ��QL�)II�%f� Contractor:
Address: 1I/I k ' Io U' Address:
�S a forte ,�f L r
Phone: C�fa I)3_llq� E-mail: I00Qfh
LeS( Iva- P 00r'(6(hone: State License Number:
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Lender:
Address:
Phone:
Fax:
Phone: Fax:
E-mail:
Application is 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
issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. 1 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. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT.
NOTICE: In additi n.,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, an here may be ad�tional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
tance f e mit verification that I will oti the owner of the property of the requirements of Florida Lien Law, FS 713.
i atur of Owne /A ent D to Signature of Contractor/Agent Date
Pri « e Print Contractor/Agent's Name
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0f7Vota $tate ida Date Signature of Notary -State of Florida Date
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w�i `r/tigenf'is e.. nown t e or Contractor/Agent is _ Personally Known to Me or
f; uoe,flb . _ Produced ID
APPROVALS: ZdlItl�3!'tii����\ UTIL: FD: ENG: BLDG:
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Special Conditions
Rev 07.07