HomeMy WebLinkAbout1300 So French AveCITY OF SANFORD PERMIT APPLICATION
Permit # : `c ko
Date: /
Job Address: / S0. F!°/Lqdl��t__Wve
Description of Work: %t[l�!/j A/0, 107. %COJtp �7Tr CL. Tctl �iPi" /�►/�Y�%C4st� j/,� /.�k✓
Historic District:
Zoning: Value of Work:
Permit Type: Building Electrical J Mechanical Plumbing Fire Sprinkler/Alarm Pool /
Electrical: New Service — # of AMPS /_ Addition/Alteration Change of Service Temporary Pole v
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
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 #:
(Attach Proof of Ownership & Legal Description)
Owners Name & Address::.. wtit'{ Q
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Phone: 116%-
336 '-e%P 3
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Contractor Namfe & Address: OC [�CrPC /"rG
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T 67d 10'eY 32-77 3
Phone & Fax: % Z. /.T�i Z
OW ontact Person:
State License Number:
Phone:
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Bonding Company:
Address: _
Mortgage Lender:
Address: I'
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 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 requirgftnts of Florida Lien
Signature of Owner/Agent
Print Owner/Agent's Name
Date
nature of Contractor/Agent Date
SnL�,f
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
_ Produced ID
APPLICATION APPROVED BY: Bldg: Zoning:
(Initial &
Special Conditions:
Contractor/Agent is _ Personally Known to Me or
Produced ID
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)
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SANFORD ELECTRIC CO., INC,
2522 S_ PARK DRIVE
P.O. BOX 2025
SANFORD, FL 32772-2025