HomeMy WebLinkAbout152 Kelly Cir (2)Permit #
Job Address: 152- Ke
Description of Work: HO
HistoricDistrict:
CITY OF SANFORD PERMIT APPLICATION
Date:
Zoning: Value of Work: $�3.JC..J
Permit Type: Building Electrical
Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS
.J'
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 —,P-- Commercial
industrial Total Square Footage:
# of Stories:
Construction Type: L�5
# of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: ' - 0 U I UDS U (Attach Proof of Ownership & Legal Description)
Owners Name ddress: dn
I rK Ire l 1 r Phgnc:
Contractor Name & Addr s: ` CF
` -1'1 MrL)dA Irk 1 • . State Licenw Nuptber: CFCcP5
Phone & Fax: Id1
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
Phone: lk�i P
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.
S?
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 PAYfNG
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 requireme of and S 713. `
Signature of Owner/Agent Date Signatu of Contractor/Agent Date
Print Omier/Agent's Name PriAContractor/Ag(rt's
Signature of Notary -State of Florida DateSigrt.T- aiUr� of Notary -State of Fl ihKY Fubl1 iC-�;W OF FLORIDA
December Ball
C7o�pmmiission # DD456022
Owner/Agent is ____ Penonall Kno n to Me or Contractor/Agent is _x Pers i� I t�Eirip jan c 31, 2009
trn ., tanuc
Produced 11) Produced ID Bonding Co., la
\I'I'I_ICA -tON APPRO\ I-1) BY: Bldg:
(Initial �� IU11i -
Conditions:
Utililics: FD:
(Initial & Date) (Initial & Date) (hrtial fi Date1