HomeMy WebLinkAbout115 E 1 St (2)Permit # :
Job Address:
Description a
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date: 3)15'V.-
Zoning: Value of Work: $ h l -4"1- 00
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 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:
Construction Type: # of Stories: of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Contractor Name & Address:
Phone & Fax3556
Bonding Company:
Address:
Mortgage Lender:
Address:
Ambitect/Eagineer:
Address:
NG VG611c Uhldi:f l-
5156UB-012 1 Contact Person:
Attach Proof of Ownership & Legal Description)
Phone:
1191-- A- 2-713
ense Number: 05 6
LVeil IN - phone:3&—G&U-gZZ% 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 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 requirem of Florida Lien Law, FS 713. 3
5 ns Signature
of Owner/Agent Date Sign re Contractor/Agent Date rr,
m I4MC, 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: Bid QU2! oohing Special
Conditions: Prim
ontractor/Agent's Name VI-
fL '3 )/ ')Y-" Signature
of:tangy-State of Florida Date DEBBIE
BLANTON MY
COWORSSION # DD l liMI Contractor >
aonal!YdiB, Prod
Utilities:
FD: Initial &
Date) (Initial & Date) (Initial & Date) (Initial & Date)