HomeMy WebLinkAbout1915 Airline Ave (2)Permit # : l / S ^�V rN
Job Address: J `1 1-:) 14 1 r 1 t'n �
Description of Work: 11 C- �dMv_ C
Historic District: Zoning:
Permit Type: Building Electrical
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential
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CITY OF SANF ORD PERMIT APC'LICATION
Date:
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Typo: Residential Commercial
Construction Type: # of Stories:
Value of Work. `l; ' t4 5-0 , 0e,)
Mechmieal Plumbing hire Sprinkler/Alarm Pool
Addition/Alteration Change of Service Temporary Pole,
— Replacement New (Duct Layout & Energy Cale, Required)
_ # of Water & Sewer Lincs # of Gas Lines
Plumbing Repair - Residential or Commercial
hidustrial Total Square Footage:
_ # of Dwelling Uuils: Flood 'Lone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Namne x Address: 5r,,,, � r d Ali r 0,',,cFlcr �- AAArr-i ),3 I Z o u Rt d t" 1 P ,/ e Void 13hM
Sear)-Zrd , C -L 3.77"7
Contractor Name & Address: r-, I A ) rl ei -
Phone & Fax:
Bonding Company:
Address:
Contact Person:
State License Number:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
Application is hereby made to obtahr a permit to do the work and installations as indicated. 1 certify that no work or utstallalion has commenced prior to the
issuance of a permit and that all work will be performed to meut sLurdards of all laws regulating construction in this jurisdiction. 1 understand that it separate
pennil roust 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 COMMENCEMENTMAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WIT11 YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this purmit, there may be additional restrictions applicable to this property that may be found in the ptib!ic records of
this comity, and there may be additional permits required from other goverzunental enlitius such as water management districts, state agonies, or federal agciiuius.
Accuplance of ppni .is verifrcatio ratt l cow Irl notify the owner of the property of the requirements of Florida Lien Law, FS 713.
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2 Signature of Owner/Agent Date Signature, of Contractor/Agent Date
Prim O r/Agent's Name Print Cuntractur/Agent's Name
n o Signature of Notary- tate of Florida Date / l ` tgnaturo of Notary-Statu of Florida Date
C!J
Z Owner/Agent is — Personally Known to Me or Cunlractor/Agent is
C► Produced ID ProducedID
95,
132� sjTION APPROVED BY: Bldg: Zoning: Utilities:
,(Initial & Date) (Initial & Date)
IPC a1 Cunditions: ill Dn )r` CL —Std
Personally Known to Me or
FD:
(Initial & Date) (Initial & Date)
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