HomeMy WebLinkAbout3504 S Orlando Drd 11 CITY OF SANFORD PERMIT APPLICATION
Application # : U 9 — J (r 5_-� Submittal Date: .00
�.S® �- s, Gr[�h 4o' Fl %r
Job Address: Value of Work: $ 3 4' S � --
Parcel ID:
Zoning:
Historic District:
Description of Work: 9:5�11q-c-" y _U�U ®4Gl C Square Footage: )Coo
Permit Type: Building ❑ Electrical ❑ Mechanical t, Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service - # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non -Residential J-11
Replacement ❑ New ❑ (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # 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
................ ........................................................ • • •
Property Owner: i l • • • • •o�y7 Contractor: t 4e4e� ' V�gyl •hG • • •�%
Address: s O Address:
a� p� l�►•� � � � 3 � � 3 �
Phone: E-mail: Phond _ 9_ State License Number:
Bonding Company: r& Mortgage Lender: V14-1
Address:
Architect/Engineer:
Address
Plan Review Contact Person:
Address:
Phone: Fax:
Phone:
Fax:
E-mail:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. 1 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 1 will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
7 x'10 7
Signature of Owner/Agent Date
Signature -of Nntrktor/Agent Date
/V c��� /Le -00
Print Owner/Agent's Name
Print Contract /Agent'sName
Signature of Notary -State of Florida Date
Signature of Notary -State of Florida Date
Vwwvv��vq,
MY COMMISSION #D,1)62466
°° t� EXPIRES: February 25, 2011
1 -800 -3 -NOTARY FI. Notary Discount Assoc, Co.
Owner/Agent is Personally Known to Me or
Contractor/Agent Is ersona ly nown o Me or
I
Produced ID
_ Produced IDI A / , n O
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
UTIL: FD:
ENG: BLDG: -
IP
LET-PERMIT AU 0 �.'-U A�IJMFI RIZATION/
IER -OF AUTHO -
RIZA.TION
(License Holder/Please Print)
hereby authorize
I - -
(Authorized Person Please Print) to obtain a permit in my behalf
under my License # for the job described below:
TYPE PRRM11 DRSCRjpTION
Building
Owner 7
Electrical
Site Address zio!6
Plumbing
.)HVAC
_X_
Tax Parcel
Roofing
Pool
Sign
Other
----------
icellle Holder Signature)
0
State of Florida
coun�y 01
Affirmed and subscribed befm.me this day of 200'2b
y
produced Who is -personally ImOwn to me or who has
(tYPe Of ID) as identification.
Signature of Notary Public, State Of Florida
(Notarial Seal)
Jaffli R Leiiaox
.1'1 Commission # DD3056638.
-Expires: March 31, 2008
Bonded Thn,
11 AfJaj:it;, Bonding Co., fric.
I 'd 6LGPON SNOM3dSNI q MUM WHO NVIti:6 LON'[punk