HomeMy WebLinkAbout3999 W 1 St_ CITY OF SANFORD PERMIT APPLICATION
Permit # : Date:
Job Address: S 9C(Ci
Description of Work: l Vl�J -�� i d i�i�c� v' M SV 0Q. vv -)f
Historic District: Zoning: Value of Work: $
Permit Type: Building Electrical Mechanical Plumbing Fire Spriukl r/Alarm lam_ Pool
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 Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:'T i
Contractor Nanre & Address:
(Attach Proof of Ownership & Legal Description)
Phone:
Phone & Fax: .� �. r 3'-Ic i k,') Phone: 3Ao- 2.\ 10'
Bonding Company:
Address:
Mortgage Lender: _ nnnA
LUUF
Address: UU1f' },
Arclutect/Engineer: Phone.,
Address:
a",i^f rZl
Application is hereby made to obtain a permit to do the work and installatt n j yl�� "tgd. cgti (hat o work or msfallation has commenced prior to the
issuance of a permit and that all work will be performed to meet standards flYl3ws 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.
OWN EWS 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 T'O 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 requir_emen s o to-i�ie i Law, FS % 13.
-G�i/
Signature of Owner/Agent Date Signature of Contractor/Agentll Dt to
Tl7CcGY1("Pr/1 Aa� _ (d _5__-v/
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is — Personally Known to Me or
Produced tD
APPLICATION APPROVED BY: Bldg:( / 6 Zoning:
` (Initial & Date)
Special Conditions:
(Initial & Date)
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k , � `x EXPIRES: Novembor 1 s�z006
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790 MONRO RU.
SANFORD, FL 32.771
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FY 407 323 9304
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P.O. BOX 4 711F5
LAKE NIONRUE, n, 32747-1366
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PATE: 03/06/2004 SHEE I MI IMBER
PROJECT NO: AO -AS -2003-18
I tRAWN: JLPE2
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