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CITY OF SANFORD PERMIT APPLICATION
Permit # : GS OCOOO 8 J/ Date:
Job Address: _ I t 3 IF, F rs T- S %- sa 1co ' d L
Description of Work: tut w
Historic District: Zoning: Value of Work: $ 2 000
Permit Type: Building Electrical V Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS /SO 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 t/ Industrial Total Square Footage:
Construction Type: # of Stories: #'of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel M + Z— r Of% (Attach Proof of Ownership & Legal Description)
Owners Name & Address: G . A -.. c(rt w Ste! eI" , 3 00 p7.•.7++ <rGia / .ST. 9CL 7 511d
Phone: P i - 3 30 - Sere eo
Contractor Name'& Address: 16- t/ C. r L Z Cr a.
3 7 d 3 State License Number: ODO rr 7
Phone & Fax: - Zq -/7 9 3 77-9 V- V C Contact Person: 1 /'7's Phone: W, 7 9 y or - d-yQT
Bonding Company: t
Address:
Mortgage Leader:
Address: '
Arcbitect/Engiueer: _ Phone:
Address: 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.
1
OWNER'S AFFIDAVIT: I certify that all of the foregoing infotmatioh is accurate and that all work will be done in compliance withal] 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.
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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 pemdt is verification that I will notify the owner of the property of the requi ts'of Florida Lien Law, F 713.
Signature of Owner/Agent Date ature of Contractor/Agent /
eDa
J&
es l ia T T'lftC Print
Owner/Agent's Name Print Contractor/Agent's Name Signature
of Notary -State of Florida Date Owner/
Agent is _ Personally Known to Me or Produced
ID APPLICATION
APPROVED BY: Bldg: Special
Conditions: Initial &
Date) Zoning:
Signature
of Notary -State of Florida Date Contractor/
Agent is _ Personally Known to Me or Produced
ID Initial &
Date) Utilities:
FD: Initial &
Date) (Initial & Date) i