HomeMy WebLinkAbout1402 W 16 St06", 3-•uf
CITY OF SANFORD PERMIT APPLICATION
Permit # :
Job Address: NO Z w • / 6 2-
Date: 3—
Description of Work: ¢..A O'
Historic District: Zoning: Value of Work: S l Z.7O • C/V
Permit Type: Building Electrical X Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration >L 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 Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel /1:
Owners Name & Addre s
y Z W•l6'J'
Contractor Name & Address: J U4L
Phone & Fax: Yt
Bonding Company:
Attachprooe hip &Legal Description)
7
Phone: -Wl Address:
Mortgage
Lender: Addrebs:
rcnnecr/
Engineer. &LA 'honor duress:
rax criic
uor. s ..ercny :::.:ae •o . o:atn ecratr; :o uo me •vnrx ::u : srwrlauuns s taui ateF. ..amr: aa[ no wor. r .:ailanon ii:s .omme nceu eaor . j tr.: su::
nce of a s mn anu chat ctl wore •.vnl be Fe: tonnea w meet uanuares or -il Laws ruguratrng com trucnon rr. iis L.rrsmurion. :.: nuersmnu ;Mat : scaarste nr
ernmubt be becured .or ELECTRICAL WORK. ?LU:AB[NG. SIGNS. JELLS. ?OOLS, FURNACES. BOILERS, 'EATERS, TANKS, ano AIR
CONDITIONERS, etc. OWNER'
S AFFIDAVIT: 1 certify that ail 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 1 will notify the owner of the property of there ments of Florida Lien L Signature
of Owner/Agent Print
Owner/Agent's Name Signature
of Notary -State of Florida Owner/
Agent is _ Personally Known to Me or Produced
1D APPLICATION
APPROVED BY: Bldg: Initial &
Date) Special
Conditions: Date
Date
Zoning:
t
Con actor/Agent's Ni M
Si
tun o tary Statin MYx
Con *`
11's i Produced
ID Utilities:
Initial &
Date) U
Date rida
Date M.
NSON SIO
t DD 2851i22 larch
23, 2008 ally
IfJjowgt;P Me or FD:
Initial &
Date) (Initial & Date)