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Permit #
Job Address: Lt 2 -
Description
Description of Work: n Z
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date: (0-0-0
et
Zoning: Value of Work: $ 3-Sa,w
Permit Type: Building 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 ---Z Commercial Industrial Total Square Footage:
Construction Type: z �qq #/of Stories:: #of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 3� v/ 3 t/ ' (�' U(✓ " Q
614 (Attach Proof of Ownership & Legal Description)
Owners Name & Address:��1
Phone: 7v 0 Zv it
Contractor Name & Address: G �_f_
3 2 73� State License Nt -her: C_ (� (� % C' �
G V� J �
Phone &Fax: p • �d D "`%O � ;j 6 " Q-1 � �%5 Contact Person: L"YI,C�.t°Jy J�--Zl. Phone: `7Lf 7 GiC-ll
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 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 wr, management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requiremen Florida Lie La , FS 713.
Signature of Owner/Agent Date ature 7onfractor/Agent Date
Print Owner/Agent's Name ri on..0 tracto Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is
_ Produced ID
Personally Known to Me or
APPLICATION APPROVED BY: Bldg: Q PJLI h 11/11 14oying: Utilities:
(Initial & Date) (Initial & Date)
Special Conditions:
'_V0
� 4Lt�
DEBBIE BLANTON
MY COMRIISSION # DD 188491
__;=nl3�grt9 Pe,rd091t or
FD:
(Initial & Date) (Initial & Date)
r-
111897
I hereby name and appoint
of
Date: 1, t - I l--O-ti
to be my lawful attomey
m fact to act for me and apply to for
a permit for work to be performed
at a location described as: Section Township Range
Lot Block Subdivision
(Address of Job)
- '�z 3
(owner ofP
aad Addmm)
and to sign my name and do all things necessary to this appointment,
Aclmowledged:
Sworn to and subscn'bed before me this
Day of Csy a A.D. XG J!