HomeMy WebLinkAbout1143 30 StJ
CITY OF SANFORD PERMIT APPLICATION
Permit #: v C/ Dat1 e: 3 I3II0 Job
Address: I i y 3 3 a+h S 4 Srxn r.1 3,9 "7 7 3 Description
of Work: 'Q GTT t C e. "e—.c V 1 0— Historic
District: Zoning: Value of Work: $ I Seal • CX5 Permit
Type: Building Electrical Jef:'Mechamcal Plumbing Fire Sprinkler/Alann 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 #:
ULD " a C3 - D 1 - 5c(VJ - QAa %C-5 - Owners
Name&Address: Air - Contractor
Name & Address: Phone &
Fax: Bonding
Company: Address:
Mortgage
Lender: Address:
Architect/
Engineer: Address:
Attach
Proof of Ownership & Legal Description) Phone:
1/0i S 5 A5- g004 Slate License
Number: Contact Person:
Freink Li h<r*4p-c- Phone: Ycr7 V/7-SOO 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 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 PR9PERTY. 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
pe ' verification!ba`-lVil tify the owner of the property of the G 3
30 1L i re
o Owner/Agent Date !i W t
0 /Agent's 14ame U< - Si
a of Notary -State of Florida bate W1 P
211 Owner/Agent is so Knot to Me or St 8 _ Produced ID APPLICATION APPROVED
BY: Blds,,)E3 - 31- 05'Zoning: Initial & Date)
Special Conditions:
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ASis Name a 3
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of Notary -State of Florida ate Contractor/Agent
is ZZM a Known to Me or Produced ID
Initial & Date)
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