HomeMy WebLinkAbout1512 Mellonville Ave (3)CITY OF SANFORD PERMIT APPLICATION
Permit # : n Date:
Job Address:
Description of Work: n V k -
Historic District: Zoning: Value of Work: $—I
Permit Type: Building Electrical Mechanical —K Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Construction Type:
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
# of Stories: # of Dwelling Units:
Parcel #: 3 /T=1, 1 –3 / – (�& �
Owners Name & Address: ) C'M & C G,\\\
Contractor Name & Address:
Total Square Footage:
Flood Zone: (FEMA form required for other than X)
(Attach Proof of Ownership & Legal Description)
Phone: I - +— -
I State License Number:
Phone &Fax: g�� ^ t, UK � 5� Co(9�r– a3,2tact Person:
Bonding Company:
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 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 maybe 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 there ire f F ri , FS 713.
Lor
Signature of Owner/Agent Date Si ature of n actor/Agent Date
Print Owner/Agent's Name Print Contractor/Agent's Name /
n,", I, C/-
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
of Notary -State
Contractor/Agent is
Produced ID _
APPLICATION APPROVED BY: Bld 0%Zoning: Utilities:
(Initial & WK (Initial & Date)
Special Conditions:
6v
POB A96M CARLSON
* MY COMMISSION # DD 076150
t EXPIRES: December 3, 2005
Budget Nota Services
=V@Pnown qR"9l'�er�Sl� 9 Notary
FD:
(Initial & Date) (Initial & Date)