HomeMy WebLinkAbout108 Anderson AveE)63
Permit
Job Address: _1
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date: A-13—
%., P
`13—
Zoning: Value of Work:
✓A ,
Permit Type: Building Electrical ✓ Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS 2O Addition/Alteration ✓Change of Service k"' femporary Pole1J/0
Mechanical: Residential Non-Residentia ep acemen New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water Replace
er Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commer al Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Contractor Name & Address:
Phone & Fax:;;PS
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Proof of Ownership &
Phone:
S icense Number. Eli 130019¢3
C�onPerson: _�A/ i y Phone:
Phone:
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 t`iic
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 (50
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 Jaws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT lad YOLI P� 1'q: y'lr'(T
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 of permit is verification that I will notify the owner of the property of the requir is of Florida Lien Law, FS 7
Signature of Owner/Agent DateSi =e of Contractor/Agenj Date
Print Owner/Agent's Name ri t Contractor/A ent's Name
Signature of Notary -State of Florida Date Signa `re o ^4�ptar E19—eEk j� GRAVE Date --
k4_0
* MY COMMISSION # DD 164280
EPI ;November 12, 2006
: !3o Th I9ud$et t�tarj ervicesOwner/Agent is Personally Known to Me or Contractah91ent rs ers na y own to Me or
Produced ID _ ProducedlD
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
(Initia Date) (Initial & Date) (Initial & Date
(Initial &Date)
Special Conditions: