HomeMy WebLinkAbout206 E 1 StCITY OF SANFORD PERMIT APPLICATION
Application # : 0-7— - 502— ,,(
Job Address: o �6 /E A S�
Parcel ID:
Zoning:
7—
Submittal Date: Zcl 0-
0
Value of Work: $_� .
Historic District:
Description of Work: ( %i4/1� e (1U X171 C ellkl1 o— Square. Footage:
..............................._.................... .....................................................................
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 ❑ Replacement ❑ New ❑ (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Commercial W Industrial ❑
Occupancy Type: Residential ❑
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair —Residential ❑ Commercial
Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
................................................................................ ....... ............
Property Owner: Contractor:
Address: Address: .ZZO Ue
Phone: E-mail: Phone: State License Number:
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. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. 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 prop y of th e en's of F aw, 7
Signature of Owner/Agent Date pat ur , of Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of
Owner/Agent is _ Personally Known to Me or
_ Produced ID
APPROVALS: ZONING:ov- l9 D OIL:
Special Conditions:
Rev 07.07
Date
FD:
Print Con tractor/A ent's ame
4.x.6 7
nature of No ary-_Sfake.Florida Date
Contractor/Agent is Personally Known to r
ProducedID.
ENG:
BLDG: