HomeMy WebLinkAbout821 Catalina Dr (3)Application # : 07'8
CITY OF SANFORD PERMIT APPLICATION
Job Address: 51)) 1 C�� �)� � pl,
Submittal Date:
Dn
Value of Work: $
Parcel ID: _ 31 - % C� - 3 f /d
r 6066 --0?6 b Zoning: Historic District:
Description of Work: r� K0y j=
Square Footage:
Permit Type: Building [Y' Electrical ❑
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Mechanical❑Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑
Electrical: New Service - # of AMPS
Sign ❑
Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non -Residential
[IReplacement ❑ New O (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 ❑ Commercial ❑
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑
Construction Type: # of Stories:
Occupancy Use Group(s):
# of Dwelling
gUnits:
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Flood Zone: _ (FEMA form required)
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Property Owner: iry) �r I�-4C'C
V'lA-,L, Z 2 v �Do ........................
Contractor: tZi
Address:
Srv� Fa
Address: f�_� 5-t: vK-rm-r Lav'tyt-erCe �(
oil � r%1 �� � 7)
Phone: 3o) - �aS - yV E-mail:
r "F --c 7�• /d- Pd P .t- r l 3 4 7 6 3
Phone: IC2"i 'L"State License Number: CCC-( 3x643 Z
Bonding Company:
Mortgage Lender:
Address:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
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
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING; CONSULT WITH YOUR LENDER OR AN PAYING
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 requirements ofy-Lqrida Lien Law, FS 713.
Signature of Owner/Agentl
Date ��— � S•O� -p 7
Signature of Contractor/ gent Date
Print Owner/Agent's Name
Signature of Notary -State .17Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
UTIL: FD:
Print ntractor/Age a
Signa Lire or' ate
°.4^ Notaiy Public State of Florida
Q Michael LaRock
' e MY Commission DD381671
O►�°a Fxoires 12/26/2008
Contractor/Agent is ?Personally Known to Me or
Produced ID F b L
ENG: BLDG:
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