HomeMy WebLinkAbout1122 Bay AveCITY OF SANFORD PERMIT APPLICATION
Permit # :_ V� Date:
Job Address: I l d �•
Description of Work:
Historic District:
Zoning: Value of Work:
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 Clo-pts Plumbing Repair — Residential or Comrnercial
Occupancy Type: Residential/ Industrial Total Square Footage: 6
Construction Type: # of Stories: # of Dwelling U lits: Flood Zone: (FEMA form required for other than x)
Parcel #•
Owners Name & Address:
& Address:
Phone & Fax: CV--/ L
Bonding Company�(�
Address:
Mortgage Lender:
Address:
Architeet/Engineer:
Address:
11.
(Attach Proof of Ownership & Legal Description)
_ Phone:
Number:
Contact Pwson: Phone:
?3 2�-'
Phone:
Fax:
Q 61
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 applic ible laws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT tN YOUR. LAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER Otic. 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 maybe additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptanceof ermit is verification that I will notify the owner of the property of the requ r&i "ts of FF da L' n [! a S713.
rgnature of Owner/Agent Date ature of Contractor/A pnt Date
17
ell /
n nerlAgen ' N e Print Contractor/Agent's Name
ignature of ota -Sta of Florida Date Signature of Notary -State of Florida Date
PATRICIA A ANDREWS
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DEBBIE BI ANTON
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APPLICATION APPROVED BY: Bldgs fD V �1./gp t/ Utilities: FD:
ni a te) UG�nur ((Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions: