HomeMy WebLinkAbout1021 W 1 St (2)CITY OF SANFORD PERMIT APPLICATION
Permit #: 6 — / Date: -
Job Address: /01R/
Description of Work: 2 bUTL€TS E7,c5er W {tj0c>,,j R•IL VAJ (723
Historic District: 'Zoning: Value of Work: $ " I'D Q,
Permit Type: Building Electrical Mechanical Plumbing 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
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy 'Type: Residential) Commercial Industrial Total Square Footage: Soo
Construction Type: �6�'J # of Stories: 'L # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel Yr: 25 r 6��� —V k -6Oz C) 0 — o o ?-A (Attach Proof of Ownership & Legal Description)
Owners Name & Address: F LL ZA 66TH U ARW I e -K
A, Phone:
Contractor Name & Address: a qq� t` a (K)M 1 ULX-/E
1'5 3 1 W. S M 1" %-�,-- t� T`; CA— F�� 3Z9c F State License Number: C--0 V 1 %9 g
Phone & Fax: Contact Person: M AM K D 0tN MV EflPhone:
Bonding Company: NlA
Address: Al 0,
Mortgage Lender: N
Address:
Architect/Engincer: N Phone:
07 - zf ZZ -7 6S7
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 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. JF 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 m , e found in the public records of
this county, and there may be additional permits required from other governmental entities such as water manqgcmcn;/.stri s state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements ofjo%la L iWL a v/F 4/1 13.
Signature of Owncr/Agent
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is _
Produced ID
Personally Known to Me or
APPLICATION APPROVED BY: Bldg: 00)Zotfing:
(Initial & Date)
Special Conditions:
Contractor/Agent 16101, Date
Contractor/Agent is Pcrsonally Known to Me or
_ Produced ID
Utilities:
(Initial & Date)
FD:
(Initial & Date) (Initial & Date)
r r, a :. Ana M. Harty
.�pS"RY PV ���
:�•
Commission
$30
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#DD260477
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Expires: Oct 21, 2007
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Bonded Th ill
Atlantic Bonding Co., Inc.