HomeMy WebLinkAbout703 Briarcliffe St (3)V.
Permit # : (9-,T - J �J
Job Address: / �jC)3��
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Zoning: i Value of Work: $ ,5-4 7"3 • rid
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 X Commercial Industrial Total Square Footage:
Construction Type:_ # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: / J (Attach Proof
of O�nership & Legal Description)
Owners Name & Address: 44&/f"' ' [ ✓: ��/�?(jR/7 Tit — ��a V��-7�e�� �i�t'• �1 �%✓/T✓
Phone:
Contractor Name & Address:
Phone & Fax: j
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Startle License Number: /L L" C>Z2 & � ;? ,/,}L
Contact Person: ,51*14E Phone: YI);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 lams 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 ill notify the owner of the property of the requirements of
$ 16 4�,57'112V,
ignature of Ow /Agent
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ignature of Notary -State of Florida Date
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OU caner/Agent is _ Wally own Me or
roducedID
Lien Law, FS 713.
Signature o/Copftactor/Agent Date
Print Con
actor/Agent's Name
it l cloy
Signa re of Notary -State of Florida Date
M. DEBBIE BLANTON
Co ra t 4yCeanalssroNave
Pro ID EXPI
I.800.3 -NOTARY FL Notary
Discount Assoc. Co.
APPROVED BY: Bldg: I J Ck6ing: Utilities: tU:
(Initial & ate) (initial & Date) (initial & Date) (Initial & Date)
itions:
r THIS IHSTRU PREPARED sy
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Stab of Flares
Permit No.
The tmdwaped hereby gives noWc that late;
713, l larids Stamps, the falkwing bEbmet
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GENERAL DESCHtMON OF XWF
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Name and add=s.
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NAM AND ADMIN OF FEE WO
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