HomeMy WebLinkAbout1200 Central Park DrCITY OF SANFORD PERMIT APPLICATION
Permit #: I
Job Address:
Description o
Historic Dish
Permit Type: Building Electrical _.A- Mechanical Plumbing Fire Sprinkler/Alarm Pool _
Electrical: New Service — # of AMPS Addition/Alteration _X 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 _X_ Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: G.O — 1 —1
Owners Name & Address:
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Contractor Name & Addr,
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OPhone & Fax: A % 6
Bonding Company: _
Address:
Mortgage Lender:
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Contact Person:
Attach Proof of Ownership & Legal Description)
Phone:
Number:
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Address:
Architect/Engineer: Phone:
Address: Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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: 1 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 asent icts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the properly of the requiremen Zr a Alm F
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Signature of Owner/Agent Date nature o or/Agent Date
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Print Owner/Agent's Name
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Print Contract
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Signature of Notary -State of Florida Date S' n ure of o State of Florida DateM JP
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Owner/Agent is _ Personally Known to Me or Contractor/Agent is Personally Known to Me or o
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Produced ID Produced ID
APPLICATION APPROVED BY: Bldg: Zoning:
Initial & Date)
Special Conditions:
Initial & Date)
Utilities: FD:
Initial & Date) (Initial & Date)