HomeMy WebLinkAbout1105 E 8 StCITY OF SANFORD PERMIT APPLICATION i; .' ii ;,., •.tr,
Permit # : Of " a a O 3 Date:
Q •fh .
Job Address: 1 2: • 8 5 rs, 2 t
Description of Work:
Historic District:
o F Sler u) c e_
1 J=
Zoning: Value of Work: $ d 10 a
Permit Type: Building Electrical V Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS 1" Addition/Alteration Change of Service 1 S0 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 _X _ Commercial Industrial Total Square Footage:
Construction Type: # of Stories: ) # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Po i3o Y (; / 6 4a
vi, i dV0 r
t od 1 L
Attach Proof of Ownership & Legal Description)
Phone: _
Contractor Name&Address: i'ri m e, L'ZIe-ctAc-di C,a,,LrJc,Ejn LLc (oa34i- i:c.(tv%9 La,-,-
O rila„Oo F( 3a `3J o State License Number: h A oo 1 4)L -7 O _ Phone &
Fax: 4107. a.ri ,(.o54 7/. Contact Person: )-ran K Phone: 40% d 6 8 $7 Bonding
Company: 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 I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. Signature
of Owner/Agent Date Signature of Contractor/Agent Date Gcl"
k J fAc)1aw i s QV_a Print
Owner/Agent's Name PrinyQontractor Agent's Name aloe
Signature
of Notary -State of Florida Date Owner/
Agent is _ Produced
ID Personally
Known to Me or APPLICATION
APPROVED BY: Bldg: Initial &
Date) Special
Conditions: Zoning:
signature
ol i-\otary- ContractorL
ProdUtilities:
Initial &
Date) DEBBIE
BLANTON MY
COMMISSION # DD 188491 EXPIR
S:RP R%pZ PersonaFY
FL Notary Discount Assoc. Co. FD:
Initial &
Date) (Initial & Date)
Permit #: V 11
Job Address:
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
I /
sf
Date:
VVe ci 4-W-C, 10 d 1,W
h
Zoning: Value of Work: $
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 )f-- 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 #:
Owners Name & Address:
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Leader:
Address:
Architect/Eagineer:
Address:
Contact Person:
Attach Proof of Ownership & Legal Description)
State License Number:
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 constriction 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 I will notify the owner of the property of the requircmentAof Florida Lien Law, FS 113.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name
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:
Zoning:
Contractor/Agent's Name
rh
DEBBIE
tuieo7M a Date BLANTON
OMMISSION #
DD 18W1 IsES:
Fj$ Fwn Me or 107
Utilities:
FD: Initial &
Date) (Initial & Date) (Initial & Date)
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