HomeMy WebLinkAbout625 Sarita St (6)CITY OF SANFORD PERMIT APPLICATION
Application #: V% - r)%� Submittal Date: / - 23 -U %
Job Address: d21` 5,W%rA --r-)• u Q 3 7-r)'23 Value of Work: $ / OOO'-
Parcel ID:
Zoning:
Historic District:
Description of Work: A4Td .4&y-nW / G42/�b�T GLoCE - !,✓ Square Footage:
•Permit Type: Building ❑ Electrical Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service - # of AMPS Addition/Alteration X 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 01 Commercial ❑ Industrial ❑
Plumbing Repair - Residential ❑ Commercial ❑
Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
PropertyOwner: / A' 72xLQ � FF-E� i Contractor: /? ELfe_T4aL
Address: 62i" :r4,,, -TA sT Address: 8/3 N w4T_6&1 w ,
SAS Faet� �1. ?zyy) 3 4Le4e2 *U yr F�
Phone: E-mail: P�o e: Z$L 6199 State License Number: ZZl3y73o2L
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. 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 I will notify the owner of the property of the requirem nts Florida Lien Law, FS 713.
Signature of Owner/Agent Date Signature of Con(ractor/AgenttDate
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Print Owner/Agent's Name Print Contractor/Agent's Name
T
Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date
EI3ItMLAN I'ON
L1a113gta FabPuary 29, 2011
"W.7.NOTARY Am
Owner/Agent is Personally Known to Me or Contr now o Me or
Produced ID Produced [D L et -Q .
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
UTIL: FD:
ENG: BLDG: