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HomeMy WebLinkAbout1112 W 8 StCITY OF SANFORD PERMIT APPLICATION Permit # : Date: Job Address: 11-1), U i 3T41 Description of Work: Total Mne Footage Historic District: Zoning: Value of Work: $ M3� Permit Type: Building Electrical Electrical: New Service — # of AMPS Mechanical: Residential Non -Residential Plumbing/ New Commercial: # of Fixtures Plumbing/New Residential: # of Water Closets _ Occupancy Type: Residential Commercial Construction Type: # of Stories: Owners Name & Address: Contractor Name & Address: BAS HEA OR CONDITi 915 W, 2K Phone &Fax: 1FO . fL ywrl a . Bonding Company: Address: Mortgage Lender: Address: Arch itectfFngineer: Address: ©r 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 Industrial # of Dwelling Units: Flood Zone: (FEMA form required ) Person: Phone: License Number: CA Co 3(o a.)— Phone: Fax: 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. 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 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, stat agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requi o Florida Lien aw S 13. Signature of Owner/Agent Date re of Contractor/Agent , Date Print Owner/Agent's Name Print on e s Narrle Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date Ku'u'vWluvvw� Y MY COMMISSION # DD629096 EXPIRES: February 25, 20l I Owner/Agent is _ Personally Known to Me or Contractor/Agent is�°�4�y Krno�naa39dsRraoc`Co. Produced ID Produced ID APPROVALS: ZONING: UTIL: FD: ENG: BLDG:_ Special Conditions: Rev 03/2006