HomeMy WebLinkAbout4035 W 1 StCITY OF SANFORD PERMIT APPLICATION
Permit # :_A0S . 3Z 5-6 / Date:
Job Address: 'yo.3S W /. 0 SfQa r—
Description of Work: T—W—MSTAck FOQ, NiCw Tit
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Historic District: Zoning: Value of Work: $_ 2 f ;�Q('L—•
Permit Type: Building Electrical Mechanical Plumbing --X, . Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteiation Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures /2 # of Water & Sewer Lines_ # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial _ X Industrial Total Square Footage:
Construction Type: �_ # of Stories: # of Dwelling Units: Flood Zone.- (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Contractor Name & Address:
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(Attach Proof of Ownership & Legal Description)
Phone:
U=Asrma, State License Number. C�� �SZIo'lg
Phone&Fax: '4o7-(e7k.lg%it4mt.?-re [o94 Contact Person: Lee 1%:%f%a5a.4 Phone:.4071 (V[.d'(9�b
Bonding Company
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
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 applicab this property at be fo ' th public records of
this county, and there may be additional permits requited from other governmental entities such ater managttllent s cls, state ag cies federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the
FS 713.
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Signature of Owner/Agent Date 67/ ta
Signature of Con Agent Date
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Print Owner/Agent's Name ?4nt Contractor/Agent' Name
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Signature of Notary -State of Florida Date Signa -titre of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or Contractor/Agent is _ Personally Known to Me or
_ Produced ID — Produced ID
APPLICATION APPROVED BY: Bldg: Zoning:
(Initial & Date)
Special Conditions:
(initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)