HomeMy WebLinkAbout316 Rachelle Ave (4)(, CITY OF SANFORD PERMIT APPLICATION
Application #: C7 1� / �0 a �J Submittal Date: _
Job Address: / d,�GG�GZile' /44t/ t° — Value of Work:
Parcel ID:
Zoning:
Historic District:
Description of Work: Square Footage:
C,t�, ,, p'�
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
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential ❑ 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: • Contractor: / �/G_ �Oi't,L �/L r— Sc
Address: Address: A2;0 y-// ed K_ 7707j— 3
Phone: E-mail: Phone:f/f State License Number: /1—Ci
Bonding Company:
Address
Arch itect/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. r
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 govemmental 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 requirements of Florida Lin Law, FS 713.
Signature of Owner/Agent Datea of Contracto &Dalol
Print Owner/Agent's Name Print o /Age s ame
Signature of Notary -State of Florida Date Si ature of N—otary-Statf of Florida Date
Owner/Agent is _ Personally Known to Me or
_
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
UTIL: FD:
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