HomeMy WebLinkAbout344 Live Oak BlvdCITY OF SANFORD PERMIT APPLICATION
Permit # : OS 3 7 (" Date: I ho , o�
Job Address: 3 14 H Lflrp na k� A)(J_r% SA Ad ,C! 2177 ?
Description of Work:
Historic District:
f
Zoning: Value of Work: $
Permit Type: Building Electrical Mechanical . Plumbing Fire Sprinkler/Alarm IPool
Electrical: New Service – # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement L.1 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 1--� Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel t#: I — o1C7 ^ 3`� �g — Q OCb OCA ` 0_ (Attach Proof of Ownership & Legal Description)
Owners Name & Address: - —Tb Inn rh c—gad 7 eyn S Y LA L-i�J P CYC k a I � 5Cirt 4,,J? /—L 3J-�% 3
4)6in 4's tPL Phoneg67 3c2q=1103
Contractor Name & Address: OvTo Ptcr,,rJc, cC 1 1 6 S l ( 741,9
Q C4 (FL 3a -?13 7 State License Number:
Phone & Fax: M6 -?,e &6-97Soi — J ��o �ro if'03.23 Contact Person: cci �!i! GL��ITLI' Phone:
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 mor 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 RESUf T fi\1 Y<>Ult PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDFR O)i 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 pudic records of
this county, and there may be additional permits required from other governmental entities such as water managemerrdiVicts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the
(I Inlay
Signature of Owner/Agent I Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
_ Produced ID
of &briAafi-19( I, V_VS 713.
of Cq�pfictor/Agent
Print Contractor/Agent's Name
Y ` Marcia Rodrigues
Sig a"ture of Notary -Stake of Florida +� My Commission DD327559
'°ip pi Expires Jtme U9, 2008
Contractor/Agent is Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg: _!j�f 119U 0� IO IJLVning: Utilities:
(Initial & Date) (Initial & Date)
Special Conditions:
FD:
(Initial & Date) (Initial & Date)