HomeMy WebLinkAbout109 Commerce Way (2)CITY OF SANFORD PERMIT APPLICATION
Application #:07 - R -51 KJ
Job Address: 9 CQ_A 1.AAP rCP W A U
Submittal Date: J 3 `3
Value of Work: S
Parcel ID: Zoning: / Historic District:
Description of Work:2t%/�(, �a2�' %z13� , %3 5_/1 s �' C y� Square Footage:
Permit Type: Building ❑ Electricals Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS '/09 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
Occupancy Type: Residential ❑ Commercials Industrial ❑
Construction Type: # of Stories: # of Dwelling Units:
Plumbing Repair — Residential ❑ Commercial ❑
Occupancy Use Group(s):
Flood Zone: (FEMA form required)
........................................................................................................................
Property Owner: %.5%/!A/ Contractor.
Address: f �/ 6621;rc"ZGI Address:
SwF , rZ 32-71-2,
Phone:' o 7 32i -716yE-mail: Ph e: �1Z�'�D >� State License Number: �� 13l' 5"3
Bonding Company: Mortgage Lender:
Address: Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
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. 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, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the require ents of rid ie w, FS 713.
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Signature of Owner/Agent Date Signature of Contractor/Agent Date
visa l/ 112 W1111111/i
Print Owner/Agent's NamePrim ontractor/Agent's ame XN§ I C0
�y 1" / r';4 rA/i
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Signature of Notary -State of Florida Date Signature of Notary -State of Floridan �•. �) gas ate' <'(,„`s
r�i 17l • Q �
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Own/Agent is ID Personally Known to Me or Contractor/Agent Is ersonally Kn �r�oB.
Pr Product
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
UTIL: FD:
ENG:
BLDG: