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1325 24 E St
CITY OF SANFORD PERMIT APPLICATION 05—I(o /� Permit # : Date: Job Address: y Des cripttori of Work: nn� Historic District: Zoning: (A /T �Value•of--Work: Permit Type: Building "q Electrical N Mechanical Plumbing Fire Sprinkler/Alarm Pool �r 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 /. -I-/ # of Gas Lines Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial Occupancy Type: Residentially Commercial Industrial Total Square Footage: Construction Type: # of Stories: I # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: Owners Name & Contractor Name & Address: Phone & I Bonding Address: Mortgage Lender: " Address: Architect/Engineer: d... Address:' Application is hereby made to obt , pen issuance of a permit and that all 6 oak will l permit must be secured for EL,FCTItICAL AIR CONDITIONERS, etc. (Attach Proof of Ownership & Legal Description) J &7* <Z d Phone: State License Number: Phone: Fax: Ua ns as.rnsiicated. I certify that no work or installation has commenced prior to the f all la:vs;regulating construction in this jurisdiction. I understand that a separate SIGNS, WELLS., PD. FURNACES, BOILERS, HEATERS, TANKS, and 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 o�pemiit �vernificati�ot will notify the owner of the property of the requirements of Florida Lien Law, FS 713. - Signature of Owner/A t Date Signature of Contractor/Agent rk M A Al 1-9 A Owner/Ag _ 's Name Print Contractor/Agent's Name Date Date Signature of Notary -State of Florida Date * * MY COMMISSION # DD 285622 EXPIRES: March 23, 2008 leriAgeiiPlsr`0�°P periled Tally Notary to We or r1 f / Produced ID v©• 60 �(4(42-5-0APPLICATION APPROVED BY: Bld�C-2-Z _ 5 fl /+ Zoning: (Initial & Date) Special Conditions: Contractor/Agent is _ Personally Known to Me or Produced ID Utilities: FD: (Initial & Date) (Initial & Date) (Initial & Date) V ,�. . * ,Z-)(, 4., - , -r , . . . i ;, �', I . . I" ane �,!� `�� a t - t V�rva 5'u 4 a 1 161 off � c6 U, ; -- --.. _f a CAUrl: �� v{ 61 015 �' 4 IL$.�r I . 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