HomeMy WebLinkAbout1001 WP Ball Blvd (2)CITY OF SANFORD PERMIT APPLICATION
Permit # : O 5 - f ! �- Date: B�
Job Address: lid C t)j f OAL L
Description of Work: Ne t, 9-cS / VeAri'i—
Historic District: Zoning: Value of Work: $ 5- 7
Permit Type: Building Electrical Mechanical Plumbing %C Fire Sprinkler/Alarm 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 I
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial _X_ Industrial Total Square Footage:
Construction Type: I # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
D ,, ,,`` pp,�,� p INC(Attach Proof of Ownership & Legal Description)
Owners Name
A&' Address: 1y�-W QkkA1�ONC, N
7306 /v• KNOA'tL be—. 914, pae m,L FL 33I54 Phone:
Contractor Name & Address:
19-(6 ku-e AV
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
5reyvi
7M 45 _ -%State License Number,:: C__FTCOS(o6�
Contact Person: SAA L)d)DJtAi Phone: 3zl —.221-1152*1
Architect/ Engineer: Phone:
Address: Fax:
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 pennit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. 1 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 ofph-t
is veli anon fat I will notify the owner o I the roperty of the requirements of Florida Lien Law, FS 713.
f ; �'?
Si n r ofOwner/ g t to JJ Signature of Contractor/Agent
NM
Print Owner/Agent's Name Print Contractor/A>?ent's Name
nature *10 ha-Sta1c,VFdo1-,_' laI NSdN Date
* * MY COMMISSION li DD 285622
EXPIRES: March 23, 2008
��'FOF r. oa\Oe Bonded Thre Bu at Notary Services
Own /Agent is Personally sown to Me �I- �7
_Produced ID LS 2 T� V/ No 2 0
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Zoning:
Date
Signature of Notary -State of Florida Date
Contractor/Agent is
Produced ID
Utilities:
Personally Known to Me or
FD:
(Initial & Date) (Initial & Date) (Initial & Date)