HomeMy WebLinkAbout346 Live Oak BlvdCITY OF SANFORD PERMIT APPLICATION
Permit #: J ^ Date: ,
Job Address: n Lf o e CiGt k Rk ,_Q
Description of Work: eel C c_.P 3 "t'on -{ �Q�'� Pi
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Historic District: Zoning: Value of Work: S (p a3 —
Permit Type: Building Electrical Mechanical f/ Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service – # of AMPS Addition/AlterationChange of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement l� New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # ofW ter Closets Plumbing Repair – Residential or Commercial
Occupancy Type: Residential Commercial ` Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: I —� 3� — �� g 0000 -^ rr�t)O�D (Attach Proof of Ownership &Legal Description)
Owners Name & Address: ��fA eut 9 ln'1 r (PaX7Pr
Phone: �(07- DIJ — 64,4t
Contractor Name & Address: _ ice') -'In P Le, 4,'r
Sr / 7M—Z, Ina /
�A., f C ?-N7 3 State License Number:
Phone&Fax: Contact Person: 3Gt4 `&,rpe(�Cfer Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Arch itect/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 thet 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 Ia c a: regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT MY )'001" PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OG AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there may be additional restrinA,Of
licable to this property that may be found in the public records of
this county, and there may be additional permits required1rom other governmental enas water managem t d� state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the Fj�ri3Wn 3.
Signature of Owner/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
Special Conditions:
Bldg: li J `="Zoning:.
(initial & Dat
of
Print Contractor/Agent's Name
1-l", :6&4- &Q Marcia Rodrigues
tg a"ture of Notary- tate of F46rida My Commission DM27559
OF w Expires June 09, 2008
Contractor/Agent is lk Personally Known to Me or
Produced ID
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)