HomeMy WebLinkAbout822 Escambia DrApplication # : y 1 3 I Ss�_
Job Address: '5.2a 1_1SC'a1*r %J. q
Parcel ID
Description of Work:y1\�Y
Permit Type: Building ❑
CITY OF SANFORD PERMIT APPLICATION
Zoning:
Submittal Date:
Value of Work: $ __. _1 r p o D
Historic District:
G �? ��Pt11 L (�S'�A,�,► -A) C100AIllo tSSquare Footage:
Electrical 2"_ Mechanical ❑ Plumbing ❑ Fire S rinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of A\QPS OQ lddition/Alteration hange 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 )
.`. /.............................................
Property Owner: /'P'I/1•�r •• ••P�i. •♦••••••••••••••••••••••Contractor•
Address: Q%'? �� lrl G Address:
Phone: E-mail:
Bonding Company:
Address:
Arch itectlEngineer:
Address:
Plan Review Contact Person:
Phone: State License Number:
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.
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Signat e o Otance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
�
wnerf gent '�JDate Signature of Contractor/Agent Date
Print Owner/Agent's Name
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Sign tua er of Notary -State of Florida Date
L.`ULI"il\�0�7
MY COMMISSION # DD629096
EXPIRES: February 25, 2011
PI. Not count Assoc. Co.
1 -800 -3 -NOTARY NOTARY aTY Discount
Owner/Agent i F124L
Produced ID
1 O V
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
UTIL: FD:
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Contractor/Agent is _ Personally Known to Me or
_ Produced ID
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