HomeMy WebLinkAbout419 Park Ave (2)�T Phon(Y,67)ne: �%J 32Z -S/3%/
Fl
Contractor -Name & Address: U
" Y d UPCT f/`� L 3X771
State .License -Number: 4-C- /3IXJ,%'Fi'3
?hone ,.;c .+ax: 3.30 .—
��{�]� 32L �rGL Contact Person: "hone: ---
3onding Company:
Address:
`dortgage Lender:
Address: _ -
rc: -hone:
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IM
naac , rnic :,. :o tae
ssuance ,.;,:.,t:rm,. ,ria maran TIM ui ;e perrormed :r, :neer ;randards o.1 --J laws renau,a.;n onsruc::on in :is junsdic.:on. ader.:anu t. a, _ _eaar.:re
permit mus Dt securedior I L C-RICAL VOR.K. °LUNlB[NG.: IGNS, ;BELLS, POOLS,r.. jRC'ACcS, 30ILcR . 3E.yiERS, TANKS. ane
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. 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 bei 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. owner. of the property fy p p rtY of the re rrerne is of Florida Liea FS
Signature of Owner/Agent Date S' ture of Contractor/Agent/� _ Date
/ iZ eS d /�/ v -
Print Owner/Agent's Name fint Cgntractor/A ent's Name \\\`\``"`��
Signature of NotaryState of Florida Date Signature of Notary-Stateof Flori • , ��M1tiu3apq. �' o j
qty
S � �J �G (`r:
Owner/Agent is — Personally Known to Me or Contractor/Agent is PersoEMJkFbown td1Ke%r-o '
— Produced ID _Produced ID =E*21 vl) 5 `
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APPLICATION APPROVED BY:, Bldg: Zoning:Utilities: kA • %ancr an" �\
(Initial & Date) (Initial &Date) (Initial & Da ����///It'i"11t l
Special Conditions:
CITY OF SANFORD PERMIT APPLICATION Sept ez r`
�^ 3�
Permit # :
Job Address: V/ 9 Aek /1 UE,/lrra
%-e
Description of Work: 30 Scdl,� -4
e f e2g?z -1;p
Historic District: Zoning:
Value of Work: S /6 i0. UIJ
Permit Type: Building Electrical
Mechanical Plumbing Fire Sprinkler/Alarm Pool
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 # of Gas Lines
Plumbing/New Residential: # of Water Closets
Plumbing Repair - Residential or Commercial
Occupancy Type: Residential Commercial
Industrial Total Square Footage:
Construction Type: # of Stories:
# of Dwelling Units: Flood Zone: (FEMA form required for other than X)"
Parcel #:
(Attach Proof of Ownership & Leg al Description)
_I
Owners Name & Address: i %f T Unt its]
v� a
/ r J7�L.Q�[j4j ekt,4
�T Phon(Y,67)ne: �%J 32Z -S/3%/
Fl
Contractor -Name & Address: U
" Y d UPCT f/`� L 3X771
State .License -Number: 4-C- /3IXJ,%'Fi'3
?hone ,.;c .+ax: 3.30 .—
��{�]� 32L �rGL Contact Person: "hone: ---
3onding Company:
Address:
`dortgage Lender:
Address: _ -
rc: -hone:
�ia,...,.s.
IM
naac , rnic :,. :o tae
ssuance ,.;,:.,t:rm,. ,ria maran TIM ui ;e perrormed :r, :neer ;randards o.1 --J laws renau,a.;n onsruc::on in :is junsdic.:on. ader.:anu t. a, _ _eaar.:re
permit mus Dt securedior I L C-RICAL VOR.K. °LUNlB[NG.: IGNS, ;BELLS, POOLS,r.. jRC'ACcS, 30ILcR . 3E.yiERS, TANKS. ane
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. 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 bei 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. owner. of the property fy p p rtY of the re rrerne is of Florida Liea FS
Signature of Owner/Agent Date S' ture of Contractor/Agent/� _ Date
/ iZ eS d /�/ v -
Print Owner/Agent's Name fint Cgntractor/A ent's Name \\\`\``"`��
Signature of NotaryState of Florida Date Signature of Notary-Stateof Flori • , ��M1tiu3apq. �' o j
qty
S � �J �G (`r:
Owner/Agent is — Personally Known to Me or Contractor/Agent is PersoEMJkFbown td1Ke%r-o '
— Produced ID _Produced ID =E*21 vl) 5 `
P "
p�_.
\
lbR.
.r f` H\
APPLICATION APPROVED BY:, Bldg: Zoning:Utilities: kA • %ancr an" �\
(Initial & Date) (Initial &Date) (Initial & Da ����///It'i"11t l
Special Conditions: