HomeMy WebLinkAbout401 W 22 Stl CITY OF SANFORD PERMIT APPLICATION
Application #: 0 C� Ka� JAIbmittal Date: 7
Job Address: �'� L' S7'1—reA( Value of Work: $ .-C.
Parcel ID: Il L Zoning: Historic District:
Description of Work: A /dLk4olf C�Cj Square Footage:
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Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool k3-� Sign ❑
Electrical: New Service - # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non-Resideritial ❑ 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 91 -'Commercial ❑ Industrial ❑
# of Gas Lines
Plumbing Repair - Residential ❑ Commercial ❑
Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
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Property Owner: 2 C Contractor:
Address:90 Address:
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Phone: 7O 1—&�a�d E-mail: e�-Z-Z /to�Q �YirG, Phone: State License Number:
Bonding Company: Mortgage Lender:
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. 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.
of
permit is,,;Veritication that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
Name
Date
ignature �tta�; aBLANTQN Date
MY COMMISSION # DD629096 ,
����.�` EXPIRES: February 25, 2011
1-R00-3•NOTARY FI. Notary Discount Assoc. Cc ;5
Owner/Agent isersonally Known to Me or
Produced IDW-V) , cl ��C✓ J� L
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
7
UTIL: FD:
Signature of Contractor/Agent
Print Contractor/Agent's Name
Signature of Notary -State of Florida
Contractor/Agent is
Produced ID
ENG:
Date
Date
Personally Known to M
d
BLDG. C