HomeMy WebLinkAbout2460 Mellonville AveCITY OF SANFORD PERMIT APPLICATION (�
V j �� Submittal Date: 1 ° 270
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+ Api�',4tio # : 7'_
Job Address: .2 !J6'n div biLit' �l� A v �'_ Value of Work: $�r i3e�G1
Parcel ID: ,31- 1 q' _91-.6Z26- UcX) "l -t 24 Zoning: r-�''- Historic District:
Description of Work: JF (4-t- rr1:00R tJD'rC-� + `e� Square Footage:
.............................................. Sign ❑ Sprinkler/Alarm-,[T
p nn..... F'.00l Q
Permit Type: Building Electrical 11El[I,- S Mechanical Plumbing Fire kler/Alarm-,❑,
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 # ol'Gas Lines
Plumbing/New Residential: # of Water Closets
T R s dential � Commercial ❑ Industrial ❑
Plumbing Repair -Residential ❑ Commercial ❑
Occupancy Use Group(s):
Occupancy ype. e r
Construction Type: # of Stories: L— # of Dwelling Units Flood Zone: (FEMA form required)
..
.... ........................,...1........................................... ...........................
Property Owner: ' 1 t...-+n,�aA
}} > \ On iitr" Contractor: 4J R tJ
Address: .z'f(rCa �1J��'1(bitiV �`t= ve: Address: 1)_66
0 ;-� 77/ C�tn�vcd:�. ��73v2
Phone'V07 2 6 % �� E -mail: -pat e t SLI 8 oI�S.,u�l , 00 Phone: � zl °c�S�7� State License Number: �� 6643i 4
Bonding Company: —Mortgage Lender:
Address:
Architect/Engineer:
Address:
Address:
Phone
Fax:
Plan Review Contact Person: 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: 1 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 ofthe propery of the requirements of Florida Lien Law.
FS 7`13.
v o � 49 lv7l��
o Date Sienature��tractor/Agent Date
Signature of Owner/Agent
Prin caner/Ager 's Name Print ontractor/Agents N me
1111
r2natu a Ifte Signature ofNotary-Slate v
��,..� Irby TOPiiER f31.Af8 \ . ,t;�• , ��i
' No" Pubk - Sbb of FW41 Q, %C10Mnvssro,t y 16 +� i►
fan Kdonal AM.—
er/ Contractor/Agent ob, • 7��
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Produced ID t� �q-- _Produced IDNz
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APPROVALS: ZONING: UTIL: FD: ENG: / +F''Lk&
''��`il`6!►iiillii\
Special Conditions:
Rev 07.07
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NOTARIZE
Parcel Identification Numberr_:?j_/q-
Prepared by: Ga 1 l Morris
1260 Saratoga Ln,
Geneva, Fl, 32732
to: D R and G, Inc.
1260 Saratoga Ln.
Geneva, Fl, 32732
NOTICE OF COMMENCEMENT
State of Fa o r da
County of Semi no e
I In II IIAII all II dill if Iia III I'll if Ili II 111111-11 1i III li -I-01-111i
MANWINWt MUNSI;, L:t_f: