HomeMy WebLinkAbout2404 Orgon Ave0 / CITY OF SANFORD PERMIT APPLICATION
Permit # C,4 0 Date:
Job Address:
v
Description of Work:
Historic District: Zoning: Value of Work: $ 6
Permit Type: Building L,- Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS 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 C ets Plumbing Repair — Residential or Commercial _
Occupancy Type: Residential Commercial Industrial Total Square Footage: C c
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 3 I I 7jtatchroofjr�f� Ownership &Legal Description)
Owrlea Name & Address: rJ1 � . , �, EC it�f P X 6
Codiractor Name& Addre� '
Phone &Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Contact Person:
License
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 r, uir ents of F o da L ri w 713.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bl04(
Zoning:
tial & Date)
Special Conditions:
Pri Con a r/ en 's Na
Signature of o'ar -State of Florida Date
FA4Ctti�,A a =3?EE BLANTON
ContractorPersonally�Knp,.yn ltp �vtoeaora'
_
Produced�ID
;-L No,,,nr Discotfnt Assoc. Co.
Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date)
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company:0"4-- License
Project Information
Subdivision:.
add s
�`-'V�
'u._ ,�%Lot #:
phone
4 I, , affiant, hereby affirm that I am the duly licensed
contractor of record for the above referenced permit, that all the foregoing information is true
and accurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accordance with the applicable codes and standards.
a4/._V'/k_1�_1
Contractor:
gLtz_/Z�
signature
printed name
STATE OF FLO A
COUNTY OF
This instrument was acknowledged before me this
above referenced individual,
duly licensed contractor with
he/she was authorized to execute this document. H
produced
WITNESS my hand and seal this
day of , _20, by the
, who acknowledged that he/she is a
, and who acknowledged that
her personally known to me or
identification.
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_;3,!0N ## DD 168491
7nbr uary 25,2000
7 ry
Public