HomeMy WebLinkAbout1025 W 3rd StP
CITY OF SANFORD PERMIT APPLICATION
Permit # : v v Date:
Job Address: 2025 W. 3 8 0 S T'
Description of Work: Rig -IZGor
Historic District: Zoning: Value of Work: S3s O c7 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 Commercial Industrial Total Square Footage: Construction
Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: (
Attach Proof of Ownership & Legal Description) Owners
Name & Address: :fA e- /1,-,IV WAY-SO-1 lOaS go. S'r, -SA)uF"j-V,7 ifl,, 3a 7 Phone:
Contractor
Name & Address: A 19 4, r 1, t. H t TO in Z')t. B'4 N (Q0 R D• AFT .fT G ry, Ir P K 1G o TS fl State
License Number: Phone &
Fa:: . id- Y73 - 8 ;L S ? Contact Person: C NA`i (v I-u44 ) =rf Phone: Bonding
Company: Address:
Mortgage
Lender: . Address:
ArchitectlEngineer:
Address:
Phone:
Fa::
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. N
TI : 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 will notify the owner of the pi SSig
nature of Owner/Agent Date C
IAD Iur)-1 N T Print
Owner/Agent's Name DEBBIE
BLANTON MY
COMt —. ;)ON N DD 188491 EXPlIE;::
February 25, 2007 Persongll4
Rq>1 AWS'Fr APPLICATION
APPROVED BY: Bldg: Special
Conditions: Initial &
Date) of
the requirements of Florida Lien Law, FS 713. Signature
of Contractor/Agent Date Name
Signature
of Notary -State of Florida Date Contractor/
Agent is _ Personally Known to Me or Produced
ID Zoning:
Utilities: FD: Initial &
Date) (Initial & Date) (Initial & Date) s-
r
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: C PA-P) License M
Owner: 1 1J o•'
name
address
phone
Project Information
Permit #: a — I HY ro
Subdivision:
Lot M
I, , affiant, hereby affirm that I am the duly licensed
contractor of record for the above referenced permit, that all the foregoing information is true
and accurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accordance with the applicable codes and standards.
Contractor: G.J— U -L9_.,.,
signature
CHI}h \AJ L L IA 1Trz
printed name
STATE OF FLORIDA
COUNTY OF
This instrument was acknowledged before me this day of fi , 2(n , by the
above referenced individual, 0 Act.; n - , who acknowledged that he/she is a
duly licensed contractor with , and who acknowledged that
he/she was authorized to execute this document. He/she is either personally known to me or
produced as valid identification.
WITNESS my hand and seal this 'f day of - , 200'
r
DEBBIE BIANTON
Z k1Y COMr.:1ISSION k DD 188491
EXPIRES: February 25, 2OD7
1.a 3.NOTARY FL Notary Di—rd Mood• Co.