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HomeMy WebLinkAbout1105 Seminole BlvdCITY OF SANFORD PERMIT APPLICATION Permit # :_ [) q'Z 5 I Date: o Job Address: Description of Work: "' Z- A'f / f ^ Historic District: Zoning: Value of Work: Permit Type: Building Electrical _V Mechanical Plumbing Fire Sprinkler/Alarm Pool _ Electrical: New Service – # of AMPS 1— 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: (Attach Proof of Ownership & Legal Description) Phone: Contractor Name & Address:�� State License Number: EC/30,D/91,03 / _ Phone & Fax: 4 ©� - 2'L ^ � rj {fp Z, Contact Person: /Gy'iey Phone: 400 -3 ZZ -303 Bonding Company: Address: ZSZZ P.�i!'%� P111.1E /9/✓�✓� FL w Mortgage Lender: Address: Architect/Engineer: Address: 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 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 regi3waing construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT LN 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 of permit is verification that i will notify the owner of the property of the reqRints of Florida Lien Law, FS 71 Signature of Owner/Agent Date of Contrac or/Agent Date Print Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is _ Personally Known to Me or Produced ID APPLICATION APPROVED BY: 131d 0 1 b 1016 ) Zo ing: [ itial & Date) Special Conditions: Pri Contractor/Agent's Name / Sig ttr Lary -S` bM*ANTON MY COMMISSION # DD 188491 EXPIRES: February 25, 2007 Co trateR64�@TiP _�+e4t1SriR�9@4f$&iP46 �4e _ roduce [ Utilities: FD: _ (Initial & Date) (Initial & Date) �3� (Initial & Date)