HomeMy WebLinkAbout1006 Mangoustine Ave (2)CITY OF SANFORD PERMIT APPLICATION
Permit # : 0-S. 1 T (P4 Date: Job
Address: 10 0 r7 A vG v er S ffti P o x D Description
of Work: ! A.1 S'r k c-t_ A / rL-001, NV ow Glf- W UR. - Historic District:
Zoning: Value of Work: S L 00 Permit Type:
Building Electrical Mechanical -J 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 _ Occupancy Type:
Residential Commercial Construction Type: #
of Stories: Plumbing Repair -
Residential or Commercial Industrial Total
Square Footage: of Dwelling
Units: Flood Zone: (FEMA form required for other than X) Parcel #: (Attach
Proof of Ownership & Legal Description) Owners Name &
Address:yAti Q Ll (CCU 0 0
b m A r/ & V S 1;/Szc Phone: Contractor Name &
Address: 1 E/LC cr 4: " /L- , /A- C r3 r -
A ; 5 / () L cf State License Number: C A—C d S -F G `/ Z_ Phone & Fax:
Bonding Company:
Address: Mortgage
Lender:
Address: Architect/
Engineer:
Address: Contact
Person:
Phone: 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 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 pemvt, 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 will notify the owner of the property of the requiremen f orida Li w, FS :13,.. 1 17 Signature
of
Owner/Agent Date Signature of Contractor/ADate Print Owner/Agent'
s Name Print Contractor/Agent's N % _ 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: DEBBIE
BLANTON MY
COW=SION
N DD 1SM1 4Conncto ent isIXPiftP r?6 M I Yr 1
C
5') • 1
L Zoning: Utilities: FD:
Initial & Date) (Initial &
Date) Initial & Date)