HomeMy WebLinkAbout1015 E 28 StCITY OF SANFORD PERMIT APPLICATION
Permit #
Job Address: 1015
Description of Work:
Historic District: Zoning: i't' Z- Value of Work:
Date: U 1- 046 -
Permit Type: Building Electrical %***' Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets_
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
1
Addition/AIteration Change of Service Temporary Pole —,/ —
Replacement New (Duct Layout & Energy Calc. Required)
of Water & Sewer Lines # of Gas Lines
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: rd pitrpat 4AuOw Ry, 12M Red rZky Ood Ryd - .SOIt
lJ
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 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 1 will notify the owner of the property of the requiremen o rida Lie aw, FS 713.
Qian e. Cn 01-28 -05 a 3
Signature of Owner/Agent Date Signature of Contrac nt ate
Di" CrON- 5. V iet 4e4jJ4 O&
APPLICATION APPROVED BY: Bldg: Zoning:
Initial & e)
Special Conditions:
011019111111.1 JUDITH EL NAC-Hm
re of Notary-Sta N0101y Pt -slaw c r onr;
COlfrf IP{i 5,20U
COIINIIN11011 '35
Contractor/Agent is !!'
Produced ID
Utilities: FD:
Initial & Date) (Initial & Date) (Initial & Date)
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