HomeMy WebLinkAbout2834 Central Dr (4)CITY OF SANFORD PERMIT APPLICATION
Permit # Date: Le, T
Job Address:a.7 7
Description of Work: Kcv t
Historic District: Zoning: Value of Work:
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Permit Type: Building X 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 Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential A Commercial Industrial Total Square Footage: / a G C---'
Construction Type:610- - # of Stories: I # of Dwelling Units: / Flood Zone: (FEMA form required for other than X)
Parcel if: (Attach Proof of Ownership & Legal Description)
/
Owners Name & Address: r� {� O 3 Ccs` / n r4- l� /L/U t 3 a,7,7 3
Phone: 7 G �Z oZ 3 — !Y- 4,_ E S`
Contractor Name& Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
State License Number:
Contact Person: Phone:
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 i verification tat Iwill tify the owner of he property of the requirements of Florida Lien Law, FS 713.
ture of er/Agent bate Signature of Contractor/Agent
Print Owne Agent's Name Print Contractor/Agent's Name
S� S p P��®RtpA Date Signature of Notary -State of Florida
COMMISSION # DD058M
EXPIRES 09/19/2005
BONDED THRU/1.888-NOTARYI
Date
Date
Owner/Agent is _Personally Known to Me or Contractor/Agent is Personally Known to Me or
_ Produced ID Produced ID
APPLICATION APPROVED BY: Bld q–U W Vning:
(Initial & Date)
Special Conditions:
Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date)
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