HomeMy WebLinkAbout121 W Jenkins Cir77+
CITYfti, sANFoICD PERMITAPPLICATION Permit #: _
Date: yJob
Address: fai J • J P kl /1 d C r -- Description
of Work: lie AL- Historic District:
Zoning: Value of Work: S. 44 D _ Permit Type:
Building Electrical _ Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical: New
Service —# of A1PS" Addition/Alteration Change of Service TemporaryPole _ Mechanical: kesidential Non -
Residential Replacement New (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: #
of Fixtures # of Water & Sewer Lines # of Gas Lines Plumbing/Nen Residential:
a of Water Closets Plumbing Repair — Residential or Commercial I iccupoucy Type:
Residential lommercial Industrial__ Total Square Footage: —_ Construction Type: # of
Stories: # of Dwelling Units: _ Flood Zone: (FEMA form required for other than x) Parcet #: Spy— L
w - 0 — —c) (,kttach Proof of ON nership & Legal Description) jwners NarRe & Addre
s: 3 p Phone:=
3 ^_ Con..actor Name &
Address: -- AIRCONDITIONINI7._ .__ S teLicen.
aNaamber: Phone & Fax: 915
MI.2ND
ST. Contact Person: 'G Phone _ Bonding Company: • — Address:
Mortgage Lender: ,•
Address:
A r
chitect/
Enghwer: MAR 0 4 ZUU Phone: Address: Fax: — ---•— Application
is !
rrteby
made to o win a permit io do the - pork and install io as d red c RE'ftciri o workorinstallationhas commenced prior to the i-,suai c
ofa permit and that all work will be performed to meet standar f ws r it in thisjurisdiction.: understand that a separate W PLUMBING SIGN
LL , ioo ll, BOILERS, HEATERS, TANKS, and permit must besec;.red for ELECTRICAL URK, , AlR CONU(TIONERS,
etc. t)WNER'S
A. rIDAVIT: I certify that a!! of the foregoing information is accurate and that all work will be done in compliance with all applicable laws rr.(ttrlating con:.truction and
zoning: WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESU..T IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER ORAN TTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT. NOTICF,: In addition to
the requirements of this permit, there may be _ 5ditionai restrictions applicable to u,:s property that -nay be found in th, public records of this county, and therm
may be additional permits reye:red from other governmental entities sut.lr as water management districts, state agencies, or federal agencies. Aix-ptance of permit
is veriftcation that I will notify the owner f the property of the requirements of Floriaa Lien w, F. 7l 3114105 Signature of Owner/
Agent
Date Signature of Cc ntractor/Agent Wte jlr/s Print Owner/
Agent'
s
Name Print on trot/Agent. _ a 0 Signature of Notary -
State
of Florida Date Si n• ure of Notary -State lorida Date N M, JOHNSON MY
MISSION # DD 285622
Owner/Agent is*_ Personal)
Known to Me or Contract P Pals l I234r20Me or Y c+---rr, : hn
3udaet Notary Service Pro -weed ID _Produce' f____— APPLICATION APPROVED BY: Bldg:
Im '§-ing! Initial & Date) especial Conditions:
Initial & Date)
Utilities: FD:
initial & Date) (
initial & Date)
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