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Home My WebLink About609 Palmetto AveCITY OF SANFORD PERMIT APPLICATION Application # : 0-7— oQ 1[! Submittal Date: 6 y Job Address: cci Value of Work: $ Description of Work: Historic District: Square Footage: .............................. r ...................................................... ..... .............................. Ga2 Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing I& 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 # of Gas Lines �{ Plumbing/New Residential: # of Water Closets Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑ Plumbing Repair —Residential ❑ Commercial ❑ Occupancy Use Group(s): Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required ) ........................................................................................................................ �a� Property Owner: e, ( n Contractor: 7 1,'1/L Address: 6� Cy XIWt,(�/iv�2 Address: Phone:7/ i�- 5t -,Z- h % mil: R17-6�46 -2ZW tl Phone:3 6-7744Z4State License Number: ALU S 7n7'tk Bonding Company: Address: Architect/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. 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 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 requirement f Florida Lie a w, FS 713. % Signature of Owner/Agent Date S nat re of C tractor/Agent. Date Print Owner/Agent's Name Armt4�ontrl&r/Agent's Name �R IbiI'm Signature of Notary -State of Florida Date Owner/Agent is _ _ Produced ID Personally Known to Me or APPROVALS: ZONING: G , l • 6 1 UTIL Special Conditions: Rev 02/2007 FD: Signature of Notary -State of JP�I�,IS C No" DECARDENAS 4 w a • StO _ ,CWM*WME*=S1iP23,1011 _�, ar oD easels Contractor/Agent is Perso 0,; ; ;;'By N86=1 NOW Assn. _ Produced ID % ENG: BLDG: l lu Gas Plumbing Services, Inc. 1377 S. Leavitt Av.:. Suite# 103 Or C' F am qty, L. 32763 / Office: (386) 7748244 Fax: (386) 775-1749 State License# CF-CO57948 LP# 408-17000 Date: 6 -) - PERMIT NO: BUILDER: ADDRESS: 66ct (��,y�Q,tp , v -- MODEL: GAS TYPE: V) 4 DELIVERY PRESSURE: I X7 ' CW C,, PIPE TYPE: CSST/GALVANIZED LONGEST RUN: kf 4� FURNACE: RANGE: < WATER HEATER: 175 lc DRYER: 30 Ic FIREPLACE: GRILL: SPA/POOL HEATER OTHER: TOTAL LOAD: ;ZU I< SIZING TABLE USED: Yl -Lf frLa e-V�2 tj2� Created by: c0 dr ad ►ij re94o/dti0ns F Apr �per/'�/t at0,6 04"V BCd/0/ /ssv 0 00r Q&' -z- 109 1 d c0adn� noes o, ospectio dt�0d dd� � Og i t2,aVj,Y z61,( A/ �Zg Wat l�2at lea z f X001 7- 1 3l ko' PERMIT # DATE, y PERMIT I Vincent Polizzi_hereby authorize (License Holder) w, Aoz�/'/ to obtain a gas plumbing (Authorized Person) pernit in my behalf under my license # CFC057948 for the job described below DESCRIPTION Owner Site Address lQ Tax Parcel # _ � �V �i-.��i- F7G-��l-dNO (Licens older signature) Date_ b12M State of Florida County of © W L Affirmed and subscribed before me this day of 20-f T_ by Who is ersonally kno o me or has produced (type of ID) as identification l t Signature of Notary Public, State of Florida Print e or Stam Na Type p me of Notary CHRISTINA DECARDENAS r: Nosy PubUc -State of Floft ' -?4 C ion E*mSep 2S, 2010 Notaries Seal '�y'; Cortrnissbn 6 DD SM16 N 8aM1td By National Notary Asp.