HomeMy WebLinkAbout810 Palmetto Ave (2)CITY OF SANFORD PERMIT APPLICATION
Application # : �l ! J Submittal Date: 5 1 h 'y7
Job Address: Value of Work: S
Parcel ID:
Description of Work:
Zoning:
Historic District:
Square Footage:
...............................................................��--,,..m,�..,,.......................................................
Permit Type: Building ❑ Electrical ❑ Mechanical 11P��..l-uliing El' 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
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential ❑ 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 OwnerContractor:G-.
Address:�i o �iYVI 0 Z >� Address. _Si (/-�- U 3
S rlA
Phone: Ali% - -,3z- Z E-mail: Phone: EJ-�1N!'52_"ta a License Number: Q -C o 7Cj cf
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. 1 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 requiremen Florida L!on Law, FS 713.
Signature of Owner/Agent Date Sign ture o ontractor/Agent Date
1 Cal"
Print Owner/Agent's Name Print Con ctor/Agent's Name
10 AM
Signature of Notary -State of Florida Date Signature of Notary -State ofXlc,0a_ e Date - _
Owner/Agent is Personally Known to Me or
Produced ID
i
APPROVALS: ZONING: UTIL
Special Conditions:
517 0,6
FD:
Contractor/Agent is
Produced ID
ENG:
Notary Pu08e -State of FbWa
r Comffds n Exom Sep 25.2010
Commbft / W 598616
BLDG:
Rev 02/2007
r
a
I Vincent Polizzi_hereby authorize
(License Holder)
to obtain a gas plumbing permit
(O thorized Person)
n my behalf under my license # CFC057948
for the job described below
DESCRIPTION
Owner
Site Address
Tax Parcel # 2 5 -/ � - fix-Aid/,)2
(License Holdenature)
Date -5-- '
State of Florida
County of *USAk
Affirmed and subscribed before me this day of 20 by ' a� l (114
Whois( ersonally known o me or has produced (type of ID) as identification
Signature of Notary ublic, State of Florida Print, Type or Stamp Name of Notary
CHRISTINA DECARDENAS
N(My pu* • Statq of FIOtia
Notaries Seal �rCoaom>ts�beSP25,2D10
Com► 8_0D 598616
> 75 vcr eai 7i
305
PLANS REVIEWED
CITY OFSANF RD
r PERMIT #.....