HomeMy WebLinkAbout1201 Albright StPermit # :
Job Address: /,20/
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
S ` , Date: 9. /;' D,5
Zoning:
Permit Type: Building Electrical _iV
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
P �IwjViCt —/0 ;4uu N
Value of Work: S
Mechanical Plumbing Fire Sprinkler/APool
_ Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair — Residential or Commercial _
Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name &
V ✓J
Contractor dame & Address: E
'36F- L
1,5 e -p /-//Y',1a,
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Phone& Fax: 113 ' ;-141. '-7 Contact Person:
Bonding Company: 4/4
Address.
Mortgage Lender:
Address:
(Attach Proof of Ownership & Legal Description)
Phone:
State License Number:
Architect/Engineer: 414 Phone:
Address:
_ Fax:
0
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. 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 requirem is of F oyidar Law, FS 713.
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Signature of Owner/Agent Date Signature of Contractor/Agent Date
Q si�
Print Owner/Agent's Name Print C W
tractor/Agent's Name
Ra ^6 —van D Quillen
Signature of Notary -State of Florida Date Signature of Notary -State of Florida r° °fdate
c` My Commission DD149979
�?or eye« Expires October 04, 2006
Owner/Agent is _Personally Known to Me or Contractor/Agent is P all Kn tolvrm
Produced ID ro u
F ,�I •�9 12� �J
APPLICATION APPROVED BY: Bldg: _ %ij aZoning:
(_
Initial'&& a17 ate)
Special Conditions:
(Initial & Date)
Utilities:
WO
(Initial & Date) (Initial & Date)