HomeMy WebLinkAbout2107 Summerlin Ave (2)I
CITY OF SAiN'FORD PERMIT APPLICATION (�
Permit # : 0_1y _ Date:
Job Address: 2/nn0�
Description of Work: fCeW1ve, rDm/4etlt' 146
aSe QA& Uaa e .w serrw r i
Historic District: / _ Zoning: Value of Work: S 3920!d
Permit Type: BuildingElectricalMechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration P""4Change 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 Commercial Industrial Total Square Footage: TSO 9. F
Construction Type: LioLsd # of Stories: --I—_ # of Dwelling Units: _� Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: nj 41VA% Z.4W$saOIV ���Fcr�%� e3� 297//
Z 10 I s'!>/lr!/!iG`YL//sem 4 a- c Phone: 409-40-
0 / ' 40. 48'/9
Contractor Name /& Address:J %r (Q -j\J
� eji4yer %3!J/ ) JjgjlJ,�/� 646 c
CJS Z Z S PAr/7ss,&ye State License Number: 6 C /30,0 10 03
Phone & Fax: 4107- 3ZZ' Contact Person: L✓ Uo Phone: 407• 51-0,M
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 ail 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 ermit is verification t I will notify the owner.of the property of the requ' ents of Florida Lienw, FS
F
e wrier/Agent Date Si' aturree of Contractor/ Date
Print Owner/Agent's Name Pri�onctgen 's Name
Signature of Notary -State of Florida Date ignatur o otary- e
BBIE BLANTON
My COMMISSION # DD 188491
tet., $1PIREa F %a 5 0
Owner/Agent is _ Personally Known to Me or Contract r/Agent is . erson ly Known �o I�tg oar
r' i -a d 6-NGtrx1 FL Notan/ Discount Assoc. Co.
Produced ID _ Produced D_ ._ T
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Zoning: Utilities:
(Initial & Date)
FD:
(Initial & Date) (Initial & Date)
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