HomeMy WebLinkAbout214 San Fernando CtCITY OF SANFORD
PERMIT APPLICATION
Application # : r " ZZ - p Submittal Date:
Job Address: � / 'j pm F,_ rr cA.yt i t cxD ui,� Value of Work: S o , ORS
Parcel ID: 3 3a— 5FT—
t C 630' 16SO Zoning: Historic District:
Description of Wo. k.. .�. • �0.C.0 5. `f� K..A .+ ( Q ..............ZtSquare :•eFootage:... .....
...............
Permit Type: Building ❑ Electrical ❑ Mechanical W.
Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential N. on -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 ❑ Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
.......................................................................................................................
Property Owner:
/�elba\ Per- e..Z_ Contractor: DICT TAIL? E..1rA5'j�'AkSiG SI. ,'tin COND
T
Address: A/ Sc�e rn a \.`f - Address: �. � 5 39 , 6'& ,Cll�
SIm �'o,,J Fl- 3 2 24 SANFORD, Fir 32771
Phone: N) E-mail: Phone '100 F531_A"IState License Number: 0%.13 I b
Bonding Company: Mortgage Lender:
Address: Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
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 requirement,of this mit, there ma a additional restrictions applicable to this
P Y Pp
this county, and there may be additionalj ermiXls re uired from of r governmental entitie uch as water in
ofI)Xmivis verAicationAhat I/vill notify the ownerA the property
Si ture of,
AK—Owner/
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
UTIL: FD:
13 53_&Se- VL)Ick
Print Contractor/Agent's
Signature of Notary
&rn &64
Contractor/Agent is
_ Produced ID _
ENG:
,ty that be found in the public records of
m cl t c , state agencies, or federal agencies
i �I
nts lorida Lietyfj6w, FS 713.
ILO RUssO
Jame
` I
of Florid
„ MIRINDAC.TURNER a
MY COMMISSION # DD 667937
°.:
. •q:
EXPIRES' June 14,2011
.
-r�' iit1�}�'q, FU!1dfl6 TP�Cu NOWY publl9 Urid9tWnt9f$
ersonally Known to Me or
BLDG:
P