HomeMy WebLinkAbout1410 W 13 StCITY OF SANFORD PERMIT APPLICATION
Application #: ct(� (1 a Submittal Date:
Job Address: W Value of Work: $
Parcel ID: Zoning: Historic District:
Description of Work: �nS3 c,, p S „`\J— Square Footage:
................................................ 0........ 0.................. ..................... 0 ....... .......... .,.
Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non -Residential 0 Replacement ❑ New ❑ (Duct Layout & Energy Cala Required)
Plumbing/ New Commercial: # of fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential ❑ Commercial ❑
Occupancy Type: Residential ❑ CommercialX Industrial ❑ Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
1.0 .... *00.09 *a q<.! foe 00 00090000900 to 0 of 99*9*0 to *too 09090099000 00 0*090 0 0 0. 0 ........... 0.0 ................................
Property Owner: `��Mf L,�l1E Contractor: �?�i `t �►^^�� �fL
Address:y-%1 �1 ��"' �� Address: J
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Phone: E-mail: Phone: VW;� N1 State License Number: CRSS 7
Bonding Company:.....,.. _ . w...,...... Mortgage Lender:.
Address: f 1 Address:
Architect/Engineer:
Address:
Plan Review Contact
Phone: Fax:
Phone:
Fax:
E-mail:
Application is hereby made oto obtain a permit to dk the work and
,�istallations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be perforined 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
this county, and there may be additional permits required from other governmental entities s
Acceptance of permit is verification that I will notify the owner of the property of the
Signature of Owner/Agent Date
Print Owner/Agent's Name
e to this operty that may be found in the public records of
ovate anage ent districts s agencies, or federal agencies.
of Florida ien w, 713.
of Contrac ent Date
Signature of Notary -State of Florida Date Signature ofNotary-Sate of Florida Date
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MY COMMISSION # DD629096
Owner/Agent is _ Personally Known to Me or Contracto F� or
2 i c>
Produced ID Pro aoT^RY ea�Rc
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
UTIL: FD:
ENG:
BLDG: