HomeMy WebLinkAbout4021 W 1 StPermit # :—I
Job Address:
CITY OF SANFORD PERMIT APPLICATION
S / Co ✓ Date: %,-�) ^ 0
Description of Work:
Historic District:
Ci � /C
Zoning:
Value of Work: $ r>� � -0 e-)
Permit Type: Building Electrical (/Me' chanical Plumbing
Electrical: New Service – # of AMPS w 0 Addition/Alteration
Mechanical: Residential Non -Residential Replacement New
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
# of Water & Sewer Lines
Fire Sprinkler/Alarm Pool
Change of Service Temporary Pole
(Duct Layout & Energy Calc. Required)
# of Gas Lines
Plumbing Repair – Residential or Commercial
Industrial Total Square Footage:
# of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: CC' A S 7—X U C j' / 1'Y C U
Phone:
Contractor Name & Address: A4 / /,e -P 51— /7-/
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: _
Address:
Arch itect/Engineer:
Address:
State License Number:
Contact Person: A17 / /C - S'r, , r Phone: �;� 7
Phone:
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 requirements of Florida ' IF
Signature of Owner/Agent Date Signa ure of Contractor/Agent Date
Print Owner/Agent's Name Prim Contractor/Agent's Name.
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
0
APPLICATION APPROVED BY: Bldg;Ab 0- G 1Zon g:
(Initial & Da e)
Special Conditions:
00
$1 � J
(Initial & Date)
-State of Florida Date
BIE BLANTON
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Utilities:
FD:
(Initial & Date) (Initial & Date)