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HomeMy WebLinkAbout1611 Terrace DrCITY OF SANFORD PERMIT APPLICArrnu Application #: 01 `1-1 Job Address: ,e /l 7i)A" C_ ey}rt'vc Parcel ID: 6 ? "A10'3©' 9105 — 0 266 ^ 60-311.9 Zoning: Submittal Date: Value of Work• $ Historic District: t ` A Description of Work: e a ���° ! ; .�v'2d�y Square Footage: � p� 11 .................................................................................................................................. Permit Type: Building Ll' Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑ Electrical: New Service – # of AMPS Addition/AIteration ❑ 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 ❑ Commercial ❑ Industrial ❑ Plumbing Repair–Residential ❑ Commercial ❑ Occupancy Use Group(s): Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required) P .. S...............................................................y................................... Pro•e•••Owner:•E•••t SS e_K Contractor: CGr' Address:' 94 BAY Ad ress: 70d 'K Q Phone-XV7 JWI '3% 1 E-mail: Photfe State License Number: SCC 13;276 �I Bonding Company: Mortgage Lender: Address Architect/Engineer: Address: Plan Review Contact Person: 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 man em nt districts, state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requi is of F d ie Law, FS 713. 50 1/1, 1 1Z Signature ofOwner/Agent Date SX., e ntractor ent Date Print Own er/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: Print ntra for/A is Name _ e Signature ofNotary-State of Florida Date MY COMMISSION # DD629096 OF � EXPIRES: February 25, 2011 1 -8 0e0 -3 -NOTARY FI. Notary Discount Assoc. Co. Contractor/Agent is Produced ID ENG: BLDG: