HomeMy WebLinkAbout110 N Virginia AveCITY OF SANFORD PERMIT APPLICATION
Permit # : ,5� I5� 4
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Job Address: 116 ! � V1 Y OO1 11 1 a -
Description of Work:
Historic District:
Date:
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Zoning: Value of Work: S
Permit Type: Building Electrical Mechanical Plumbing _� Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS Addition/Alteration Change of Service Tempot�ry Pole t
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 Z Commercial _ Industrial _- Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: _ Flood Zone: (FEMA form required for other than X)
Parcel #: 30-11 - 31 " $0 Z - (33w- 631a ---(Attach Proof of Ownership & Legal Description)
Owners Name & Address: V 1 r I n k c,= Ave -
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Contractor
Name t& Address:
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State
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Phone & Fax: a—G olalq- Q$�ti - l %�i ,rj- 7� %nlact Person: - M e- 1_(,4Ll +O Y1 Phone: Mot(
Bonding Company:
Address
Mortgage Lender
Address:
ArchitectJEngineer: Phone:
Address: Fax:
Application 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
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 W 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 p 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 man a nt districts, state agencies, or federal agencies.
Acceptance of permit is verification that I sill notify the owner of the t)ropeny c;f the require is frFlori a ien Law, FS 71
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Signature of Owner/Agent Date Sign ure of ontractor/A ent Date .i`11110",
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Print 0\.ner%Agent's Name Print Contractor/Agent's Name c,
5 anawrc of Notary State of Florida>ei: �ILtlalnr of tiotan 5latelilJFlonda Date
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