HomeMy WebLinkAbout1915 Airline Ave (2)CITY OF SANFORD PERMIT APPLICATION
Permit #: 01� 3�0 8101057A -V Date:
Job Address: J 9 57 � -lAir"
Description of Work: zL, ,e_ C-04ror
Historic District: Zoning: Value of Work: $ L) C)0
Permit Type: Building Electrical _
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: # of Stories:
Mechanical Plumbing Fire Sprinkler/Alarm Pool
_ Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Oras Lines
Plumbing Repair — Residential or Commercial
Industrial Total Square Footage:
# of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:(� ^/� nn (Attach Proof of Ownership & Legal Description)
Owners Name & Address: San r a A %r 1por 3r -A,, Ali carj 17- O0 R&CI C \ -1/ e 1Cn1 131Yd
5arNVbrd 1 rl 3x773 Phone: 15107-59G- 40e*pe1
Contractor Name & Address: (S4 A ) n er
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: .
Address:
Arch itect/Engineer:
Address:
State License Number:
Contact Person: Phone:
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 appiicable 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 p�erni is verificatioat I w ll notify the owner of the property of the requirements of Florida Lien Law, FS 713.
_ 8 _.e7_ 0S_
ru Si nature of Owner/Agent Date Signature of Contractor/Agent Date
I Prim 0 r/Agent's Name Print Contractor/Agent's Name
•O y
r Signature of Notary- tate of Florida Date ignature of Notary -State of Florida Date
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W
= Owner/Agent is _Personally Known to Me or Contractor/Agent is,
8 m _ Produced ID _ Produced ID _
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y+ipl' ' TION APPROVED BY: Bldg: Zoning: Utilities:
k-i'tPonditions:
(Initial & Date) (Initial & Date)
(SrA pnr Cl-,s,,j
Personally Known to Me or
FD:
(Initial & Date) (Initial & Date)