HomeMy WebLinkAbout708 S Oak AveCITY OF SANFORD PERMIT APPLICATION
Application #0J Submittal Date: -;7
Job Address: 7 J • UQi y Value of Work: $
Parcel ID: �S ` C - �- - - - C� [ Zoning: Historic District:
Description of Work: /t ? rL c Square Footage:
...................................... F: ............................................................................
Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing ❑ 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 )
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Property Owner:G iy, Contractor:
Address: % Address 1377,'i
Phone:�N- 3/ Lt -4% E-mail: Phone:_3&'77 824}St to License Number: L -F605 767 L' 9
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. 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 4ature
7-7///"//
nts of Florida Lien Law, FS 713.
,0-7
Signature of Owner/Agent Date Stractor/Agent Date
Print Owner/Agent's Name P=ontractor/Agent's Na e
Signature of Notary -State of Florida Date Signature of Notary -State of Florida
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• re.— 1 T LL i
Owner/Agent is _Personally Known to Me or Contractor/Agent is Person414.12
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Produced ID Produced ID Q+ x
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APPROVALS: ZONING. UTIL: FD: ENG:�C` G I W- .
Special Conditions: twoOrt cP ed �//TqR
Rev 07.07
I Vincent Polizzi_hereby authorize
•(License Holder)
z ,C to obtain ag
as plumbing permit
g P
V'thorized Person)
in my behalf under my license # CPC057948
for the job described below
DESCRIPTION
Owner
Site Address 70 �.
Tax Parcel #
Date
State of Florida
older signature)
6 --20..
County of \�pIy,si 0. J�
Affirmed and subscribed before me this 20 day of :Ykne. 20_g� by VI n Cen ��I t Z 7-I
Who is erso�known fr has produced_
6 -24 -of
Signature of Notary q blic, State of Florida
MICHELE A. ZAWATSKY
Notary Public - State of Florida
-.'* : • MYComm�lonE0%Jtn24,2008
Notaries Seal
Commission # DD331967
Bonded By Naflonol NotaryAssn.
(type of ID) as identification
roi c,l e. l -e- H Za��s Y
Print, Type or Stamp Name of Notary
PERMIT #
DATE:
FICE
Al.
ANS REVIEWED
i uF SANFORD