HomeMy WebLinkAbout215 S Sanford Ave (4)CITY OF SANFORD PERMIT APPLICATION
Application It
Job Address
Parcel ID:
Description of Work:
Zoning:
Submittal Date: ` G
Value of Work: S �<,O
Historic District:
Square Footage:
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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 # 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)
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PropeyOContractor: /
Address: CP o 2-
5 Address:
IA64 A,- �,4— a (� 0
Phone: , �C `j � 3,U -mail: Phone: State License Number:
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. IF YOU INTEND TO OBTAIN FINANCING; CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In add
this county, ere may
Accep ce of permit is ve
Sigoatumof0�
quirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of
additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
ration that will notify the owner of the roperty of the requirements of Florida Lien Law, FS 713.
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Signature orNotary-Stata of on4a `'
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Owner/Agent is Personalt' t
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APPROVALS
UTIL: FD:
Special Conditions: NOQ
Rev 02/2007 �Lj t✓l r5, d k\-:� 6e—
Signature of Contractor/Agent Date
Print Contractor/Agent's Name
Signature of Notary -State of Florida
Date
Contractor/Agent is _ Personally Known to Me o�ZSIv�
Produced ID ���Jllll
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