HomeMy WebLinkAbout229 Bristoz Cir1�(04- CITY OF SANFORD PERMIT APPLICATION
Application N: V 1. ��// Submittal Date: rr��
Job Address: V� k (i5I ( , C, l�(� Value of Work: $y`_5b " °U
Parcel ID:
Description of Work:
Zoning:
Historic District:
Square Footage:
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Permit Type: Building ❑ Electrical ❑ Mechanical Eig-- Plumbing ❑ Fire Sprinkler/Alarm 0 Pool ❑ Sign 0
Electrical: New Service — # of AMPS Addition/Alteration ❑ Change of Service ❑ TemporaryPole ❑
. 0000.
Mechanical: Residential ❑ Non -Residential D Replacement ❑ ' ` `. New ❑ (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # ofGas 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)
..............0......................;..................................................................................
Property Owner: JC ` H I � Contractor:
Address: 7_7;_7w`r %GZ C Address:
Phone:'(_i 3 ' OT3 mail: Phone: State License Number:
Bonding Company:. ,. _... „ .. w . v....... 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 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.
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Acceptance of permit is verifi on that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
Signature of Owner/Agent I Date Signature of Contractor/Agent Date
Signature of Notary -State of Florida Date
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DEBBIE rgL j o
MY COMMISSION # DD629096
EXPIRES: February 25, 2011
Owner/Agent is _ Peiso _ 1A
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
UTIL: FD:
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Contractor/Agent is _ Personally Known to Me or
Produced ID
ENG:
BLDG: