HomeMy WebLinkAbout2201 Washington DrApplication #: o� ✓ 3 3 1
CITY OF SANFORD PERMIT APPLICATION
Job Address: Z 2e) �� et .Sh) r t V_c
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Submittal Date: ! 2 ) D /
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Value of Work: $ �b - c-) O
Parcel ID: Zoning: Historic District -
/t9 v/1 pt
Description of Work: C Square Footage:
•Permit Type :• Building ❑. • • • Electrical Mechanical .❑......
• • • . •Plumbing ❑.....
• • • •Fire Sprinkler/.Alarm Q • • • • • Pool •❑ ......
••••• Sign .
❑
Electrical: New Service - # of AMPS G") 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
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential EY Commercial ❑ Industrial ❑
Construction Type: # of Stories: # of Dwelling Units: _
# of Gas Lines
Plumbing Repair -Residential ❑ Commercial ❑
Occupancy Use Group(s):
Flood Zone: (FEMA form required )
............................................................................. .. ... ..................
Property Owner: 1/" Contractor:
Address: �l (`� Y> Address:
Phonv �`71� '45-77 E-mail: Phon73Z/ Jrg9`/ State License Number: 1 Z7 Z -
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 mana istricts, state agencie era] agencies.
Acceptance of permit is verification that I will notify the owner of the pr ert of e require its of F r da L n Law, FS
Signature of Owner/Agent Date ignature of Contractor/Agent
Date
(a ;u c�i 4�r I / 7
Print Owner/Agent's Name Print Contractor/Agent's e �
Signature of Notary -State of Florida Date Signature of N a -State of Florida ate
NOTARY PUt f iC-STATF. CF 77, ®r, T)A
C01�aMls-sxon # L)t);,74z9S
77,
$ONI)EU Tt:i:il ,:Irl"YTIC lluidDIItiG CO., INC.
Owner/Agent is _ Personally Known to Me or Contractor/Agent is ! Personally Known to Me or
Produced ID Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
UTIL: FD:
ENG:
BLDG: