HomeMy WebLinkAbout1200 Central Park Dr (2)Permit # : C93 / 5 0 O
Job Address:
Description of Work:
CITY OF SANFORD PERMCI' APPLICATION
Date:5—
B11671S
Historic District: Zoning: Value of Work: $O O
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 Cale. 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 #:
Owners Name & Address:
Attach Proof of Ownership & Legal Description)
Phone:
Contractor Name & Address: t/ ly4y%p State License
Number: Phone & Fax:
Bonding Company:
Address: Mortgage
Lender: .
Address: Architect/
Engineer:
Address: Contact
Person:
Phone: 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 requirements of Fl i1rida- _WZ , FS 713, - i> Signature of
Owner/Agent Date zm,A/
lureofContractor/Agent
Date v l
Print Owner/
Agent's Name Prin Contract /Agent's Name J// Signature
of
Notary -State of Florida Date Signature No - Flora Date DE8B1E 13LANZ188491
m OP' ' . 'siON # T rDOwner/Agent
is Personally Known to Me or Contracto /Pugemt r,_ Personally kC OO 41r Produced ID
Pr uc — `` WV Dis--ounc APPLICATION APPROVED
BY: Bldg: Zoning: Utilities: FD: Initial & Date) (
Initial & Date) (Initial & Date) (Initial & Date) Special Conditions: