HomeMy WebLinkAbout2715 S Orlando Ave05
Permit # C
Job Address:
CITY OF SANFORD PERMIT APPLICATION
C
Date: '/ �U J
��
Description of Work: I nGt jr I \ H00a 1145 lem
Historic District: Zoning: Value of Work:
OM
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 _V 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
Occupancy Type: Residential Commercial Industrial
Construction Type: # of Stories: # of Dwelling Units:
Parcel #:
Owners Name & Address:
Plumbing Repair — Residential or Commercial
Total Square Footage:
Flood Zone: (FEMA form required for other than X�
(Attach Proof of Ownership & Legal Description)
Phone:
Contractor Name & Address: 167 CI� UIVl "?_ ?0o
c7 ��-7 2—f%nn State License Number:��
Phone &Fax: d I % n ct Phone:
Bonding Company: wrX
Address: nnGG
Mortgage Lender:r UD
Address: "
Architect/Engineer: ._.
_ �:> . _ '. Phone:
Address a. Fax:
Application is hereby made to obtain a pernmit r 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 ELECM' AL 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: hiddition 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, a4d there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance ofi ermit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, F 713.
Pi k ] C - Z_~
Signa re o wne6Agent Date Signature of Contra r/Agent Date
Kskoe SON
Print gent's Name
vJ�
Signa o N Date
� MY ommission D2 644
,� Rd Expires January 05, 2008
_V Produced is & Personally J llyq� ]]��,�99wn t_ o e or
Produced ID 'DOD I �-taJ' 0
Print
Signature of 0tdv-Slfi4jd& �_J Datt
My Commission DD249644
oF #%/ Expires January 05, 2008
C4rYtraSon
ctor/Agent i Pe a 1 Known to Me / or
Produced ID�ys 1 U
APPLICATION APPROVED BY: Bldg: q L Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date) ( ilial &Date)
Special Conditions:
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