HomeMy WebLinkAbout261 E Airport BlvdCITY OF SANFORD FfERMIT APPLICATION
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Application #: � A Submittal Date: to lao
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Job Address: fT Value of Work: x O 0, 0 d
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Parcel ID: _ � e� "o2D 30 100 - d%�7�-lam% O clo Q Zon ng: Historic District:
Description of Work: TTe/y1�n%d 1 !�Gii��l� f'' Square Footage:
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Permit Type: Building Electrical ❑ Mechanical 11Plum S 11 ing ❑ Fire Sprinkler/Alarm ❑ Pool ❑
Electrical: New Service - # of AMPS Addition/Alteration Cl',, 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 I # of Gas Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential ❑ Commercial Industrial ❑
Construction Type: # of Stories: # of Dwelling Units:
Plumbing Repair - Residential ❑ Commercial ❑
Occupancy Use Group(s):
Flood. Zone: (FEMA form required )
71
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.ProperOwner: )5A-1
n /Zi(r r� Contractor: 'K
, ` 10Atye to d< � rei,� �cj
Address: l 136 L/-",- Ce147 -ra.. _15 [Vdi Address:PI 1r4 i'1il k, 7 QOl1��
Phone: 116%-2%fd' mail: Phone:]%b- Q ls3,;8tate License Number: CG iC 0 a
Bonding Company:
Address:
Architect/Engineer:
Address
Mortgage Lender:
Address:
Phone:
Fax:
Plan Review Contact Person: ✓//I �G x"`s— Phone: �7D%'�- Fax: E-mail: %iW `L yiD%4bLU� n55 h
3556 • c:o
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 management districts, state agencies, or federal agencies.
Acceptance of permit is'verification that I will notify the owner of the property of the re o"fTlo'nien Law, FS 713.
Signature of Owner/Agent Date S ,-nature of Contractor/.Agent Date
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Print Owner/Agent's Name Pr Contra r/Age 's Name %
Signature of Notary -State of Florida Date Signature of Notary -State of Florida
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Owner/Agent is _ Personally Known to Me or Contractor/Agent is _ Personally Knorr to mete on v ®® P .
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Produced [D Produced ID "� _ _
APPROVALS: ZONING' ! UTIL: (� FD: '
Special Conditions:C U 1/1/ .1e� Nom#_ �( /� iuC� ' r '
Rev 07.07
ENG: