HomeMy WebLinkAbout111 E First StV S-Odt"C9 CITY OF SANFORD PERMIT APPLICATION
Permit # : Date: 4 ZG o b
Job Address:
Description of Work: i e—w .94Lr v 1 A, -- Historic
District: Zoning: Value of Work: $ Permit
Type: Building T—
Electrical
IX Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical:
New Service — # of AMPS /# too A 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 (I/ Industrial Total Square Footage: 31 o S r
Construction
Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than x) 4
Parcel #.
L S l % (Attach
Proof of Ownership & Legal Description) Owners
Name &Address: C7 . %+ r-e w 700 -Sara V.- 3Z77/
Phone: (l07- 330NS-90 Contractor Name &
Address: !/ f- U Jt e. ran rC Z s 3 S OV LY" (a.- d /1 d r i-/o
0 jL rC— 3
M-i O 3 State License Number: 000 $ 76 l Phone & Fax:
7 Contact Person. J / 22+ Phone: Y,0 i- Bonding Company:
Address: Mortgage
Leader:
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 mat 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
AFFIDAVI : 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 requirtents of Florida Lien Law, FS 713. Signature of
Owner/Agent Date Sign Jam Print
Owner/
Agent's Name PrAContracU Signature of
Notary -State of Florida Date Owner/Agent
is _ Personally Known to Me or Cent Produced ID
APPLICATION APPROVED
BY: Bldg: Initial & Date)
Special Conditions:
Lkart-ec
s Name
DFBBIE BLANTON
MY CoNcG :,:
S10N # DD lOS491 EXPIFES: February
25, 2007 Zoning: Utilities:
FD: Initial & Date) (
Initial & Date) (Initial & Date)