HomeMy WebLinkAbout1912 Sanford Ave (3)CITY OF SANFORD PERMIT APPLICATION
Application #: 01– JC/92 ll Submittal Date: (0. Z. Z+ _o2
Job Address: I Q 12 5AAJ E-0 Value of Work: $ ^-4 W-0—
Parcel ID:
Description of Work: ac MOU P_
Zoning:
Historic District:
Square Footage: ¢506
..............................................................................................................90.........
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Permit Type: Building ❑ Electrical is Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service - # of AMPS 2,150 Addition/Alteration ZP"4 Change of Service 9--- 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 Plumbing Repair - Residential ❑ Commercial ❑
Occupancy Type: Residential ff"_ Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: AJ cl. # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
................... �................ ... 99...........9........0.........0.00......0.9...........0.0.........
Property Owner: (G Contractor: 59L&2Zd/am,e fQ
Address: ?, N G af_re— Address:
2, 1,00" OA9 7-e- F'L 37J e �- �9NFv✓� .,= e, -
Phone:
Phone: E-mail: Phone: *%3Z2i,QAtate License Number: 6y"/3C36,/t�'y�.�
Bonding Company:
Address:
Arch itect/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 requi isof Florida Lien Law, FS 713
x/4,0 1;-22-09
Signature of Owner/Agent Date Si ature of Contractor/Agent Date
Rimes �eP
Print Owner/Agent's Name rint Agent's N
Signature of Notary -State of Florida Date Signature ofNotary-State of Florida Date
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ro6iM%SSION } b
i :NZ r 4'/R S: Februa D,20 20
2596
Owner/Agent is _ Personally Known to Me or ContractorlAgenfhs �wr��o a or
Produced ID Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
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