HomeMy WebLinkAbout125 N Summerlin AvePermit #.O , 'p, u l
Job Address:
CITY OF SANFORD PERMIT APPLICATION
Date: / N ' 19` oS
Description of Work: CV2,1/v ke OIC 5eall!C FYOtV Ott 7
Historic District: Zoning: Value of Work: $ OV0 qu
Permit Type: Building Electrical ✓ Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS _7-00 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 _1ZCommercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: p /(� (Attach Proof of Ownership & Legal Description)
Owners Name & Address: � �� ff K616b n f
,SA^� e M Phone:
S/�Q/' �3� • C �gT+
Contractor Name & Address: 4AiFVc E(Ge''(- M_ 2i11C' 2.�Z7_ 5 .di4/I~ n,0_
Phone & Fax: + • 32Z' ��(o Z Contact Person:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
LicenseeNNuu mber: 6 C 13001943
YN �)� 44,$Qky Phone: �A/N I
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 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 re 'rem nts of Florida Lien
Signature of Owner/Agent Date nature of Cc actor/ nt Date
Print.Owner/Agent's Name P 'nt on ctor/A 's N e
Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date
P RPOe�% FLORENCE A. DE (RAV,
* MY C MISSION ## DD 1642✓;
Owner/Agent is _Personally Known to Me or Contrae t#t isFTX a .• g �i II fz �(to Me or
Produced ID _ Produced ID
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
(Init 1 & Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:,