HomeMy WebLinkAbout106 Laurel DrCITY OF SANFORD PERMIT APPLICATION ,r'','•'
Date: Permit # :
Job Address: D o r-el r'
91P J" `(VDescriptionofWork: VN%P-tom
as
F[istoric District: Zoning: Value of Work: $
Permit Type: Building Electrical-- Mechanical Plumbing Fire Sprinkler/Alarm Poo]
Electrical: New Service - # of PS Addition/Alteration Change of Service TemporaryPole Mechanical:
Residential Non -Residential Replacement New (Duct Layout & Energy Cale. Required) Plumbing/
New Commercial: # of Fixtures of Water & Sewer Lines # of Gas Lines Plumbing/
New Residential: # of Water Closets f/
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 #: , —
SJ- 30 G-- (Attach Proof of Ownership & Legal Description) Owners
Name 4Address: ' Phone:
Contractor
Name & Address: State
License Number:AIRCON111110NING -- Phone &
Fax: _ -" 915 R 2140 htact Person: _ _ i2rf i - Phone: r
i Company:
BondingAddress:
Mor'
gage Lender: Address:
Arch
itect/Engineer: Phone: _ Address:
Fax
Applicatian
is hereby made to obtain a permit to do the work and instaliat;ons 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 rrgiitating construction
and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR P.4 `ING TWICEFORIMPROVEMENTSTOYOURPROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDEI- 01.Z AN ATTORNEY
L'FORE 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 re -mils required from other governmental entities such as water mam<gement districts, state agencies, or federal agencies. Acceptance
of permit is verification that [will -notify the owner of the property of the requirrnts of Florida Lien, FS
7 /V/
O Signature
of Owner/Agent Date Signature of Contractor/Agent , Date Print
OwniiiAgent's Name Signature
of Notary -State of Florida Date Owner/
Agent is _ Produced
ID Personally
Known to Me or APPLICATION
APPROVED BY: Bldg: 't/ ' Zoning: Initial &.
D te) Special
Conditions: 4 '
J V r _ s
Name r 1,
h 3 5 Si •-,
a e of otary-State of FioridaLl Date t (
A'
AIAN
M, J W%S0N c
PIPES: March 23,5 008$ Contractor/
Agent is 4all-%N0 AM44 N Produced
ID 'r _ ^ -- utihtias:
Initial &
Date) (Initial & Date) FD:
Initial &
Date)