HomeMy WebLinkAbout1122 Bay Ave (2)Permit # : a-�- -
Job Address: //Z2
Description of Work: _
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date: oro ..51 e 7
Zoning: Value of Work: $ dy Gelly-40
Permit Type: Building Electrical "4— 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:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone:(FEMA form required for crttaer thaoi x)
Parcel #:
Owners Name & Address:
(Attach Proof of Ownership & Legal Description)
Phone & Fax: Contact Person: Phone: 4co7-
Bonding Company: A
Address:
Mortgage Lender:
Address:----.�._-----------_
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 conitiu.7rced 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 understated 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 later=: regulatinp_
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESLffIN IN S''UU-R l'A.YIP7CY
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LL^'N OR ANATTORNEY 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 regairargents of Florida Lien Law. -FS 713._/) /%
Signature of Owner/Agent Date 'gn re of Contractor/Agent ate
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: Bldg: Zoning:
(Initial & Date)
Special Conditions:
PW%..9
�Pri"tcontractor/Agent'sNamc�,�..,�
Signature of Notary -State of Florida Date --
DEBBIE BLtjN
o a / 9l�i6ONibllS 1ON #yDD 88n to 491 M or
a dl�
-e
ruary 25, 2007
1'800-3•NOTARY FL Notary Discount Assoc. Co.
Utilities:
(Initial & Date) (Initial & Date) (Initial & Date)
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