HomeMy WebLinkAbout121 E Coleman CirUS-3;03k ..._
D CITY OF SANFORD PERMIT APPLICATION
Permit # : / .. 7_ as - Date: AJobAddress: /.i/E l/79AH (i/'
Description of Work:
Historic District: Ald Zoning: Value of Work: $ Voa
ao
Permit Type: Building Electrical _X Mechanical Plumbing Fire Sprinkler/Alarm per)
Electrical: New Service — # of AMPS 0' Addition/Alteration Change of Service _X 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 #:
Attach Proof of Ownership & Legal Description)
Owners Name & Addre s: OG/PmRn
QC Phone:
Contractor Name & Address: rjSi *tAC/Td GIeL%/'•-c IOG 4 m,?f
3 L'
6 State License Number:
Phone & Fax: Contact Person: Phone:
Bonding Company: rQ
Address:
Mortgage Lender: w /
Address: "
Architect/Engineer:
Phone:
Address:
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 comment
ced
prior to the issuanceofapermitandthatallworkwillbeperformedtomeetstandardsofalllaws, regulating construction in this jurisdiction. I understand that a separate permitmustbesecuredforELECTRICALWORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIRCONDITIONERS, etc. OWNER'
S AFFIDiAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructionandzoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICEFORIMPROVEMENTSTOYOURPROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFORERECORDINGYOURNOTICEOFCOMMENCEMENT. 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 thiscounty, 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 requirepe ts of Florida Lien Law, FS 713. , Signature
of Owner/Agent Date 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: Bldg: Zoning: Initial &
date) Special
Conditions: of
Print
Date
Sr
a"tuYe of Notary -State of Florida (/ Date JO
ANN M. JOHNSON r *
My
MISSION # DO 285822 XPIRES:
March 23, 2008 Contractor/
s E%lls.Pitsll(judQaiNd Yt$F941F or Produced`
r9l Initial &
Date) Utilities:
Initial &
Date) FD:
Initial &
Date)