HomeMy WebLinkAbout111 Magnolia Ave (3)CITY OF SANFORD PERMIT APPLICATION
Application #: /� 413?
Job Address ��r� t�lC��✓1iL//!/t;
Parcel ID:
Description of
Zoning:
Submittal Date:
Value of Work: $Y 4!�,qc) cr
Historic District:
Square Footage:
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Permit Type: Building ❑ Electricalrlo"
Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS Addition/Alteration ❑ Change of Service fzY'� Temporary Pole ❑
Mechanical: Residential ❑ Non- esidential O 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 0 Commercial ❑ Industrial ❑
Construction Type: # of Stories: # of Dwelling Units:
Plumbing Repair—Residential ❑ Commercial ❑
Occupancy Use Group(s):
Flood Zone: (FEMA form required)
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Property Owner: Contractor:/I'1�1i�.__l�t�i�Z'
Address: Address:y �� r
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Phone: E-mail: Phone -.4437f IOvState [cense Numbe� . /_ IP '15", g5-
Bonding
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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, 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 requiremefits orida Lie w, 713.
Signature of Owner/Agent Date`Si ature of Contractor/Agent Date
�
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 02/2007
UTIL: FD:
P t Con actor /A is Name
Signature of Notary -State of Florida Date
Contracto sp MY���481Ia� AW126%t or
Pro °—PIRFS: F wary 25, 2011
I 800.3 -NOTARY Fl. Notary Discount Assoc. Co.
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