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HomeMy WebLinkAbout540 Valencia St (2)U CITY OF SANFORD PERMIT APPLICATION �^ Permit #: 0 U / / �ry Date: / dry- 0 %-�J Job Address: 54-/C Yb/��C/�,/o c�T. c X_�9` ) r6_ Description of Work: ,CSC-� V Qn'� � Q2D / Historic District: Zoning: Value of Work: $ Permit Type: Building Electrical N 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 Commercial Industrial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: - / - 0 U /' U V (Attach Proof of Ownership & Legal Description) Owners Name & Address: Qf%'/ C / �` • �/ %� L//0 Vb/a,nc,�y0 C � { � � � Phone: Contractor N__ame��& Address: ! /tom /'l/i�'S C T7'C t71e C -h / C' �� �_��Y7 i/s • cS7�' A� ©f Kl/Y�b� � � (7�y State License Number: Phone & Fax: YO-) ;pgz D?897-c;6_,ZJtontact Person: 7('7 � • /CYTi�SSCAk Phone: V0 ') 897 QQQ 9 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 this county, and there may be additional permits required from other governmental entities such as grafi Acceptangg-g5permit is verifi that will notify the owner of the property of the Signature of Owner/Agent la 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: Bldg: (Initial & Date) Special Conditions: Zoning: that may b and in the public records of iistricts agencies, or federal agencies. Date Florida � Contractor/Agent is _ Persor nonally Known to Me or _ Produced ID (Initial & Date) Utilities: a,-riarette Brown My Commission DD172444 Expires December 16, 2006 FD: (Initial &c Date) (Initial & Date)