HomeMy WebLinkAbout1509 W 13 Sti 010 CITY OF SANFORD PERMIT APPLICATION
C i Ir Permit #, - • -. _ 0G (/ —/15y
Date:
Job Address:
A ,
C'..d
Description of Work:cdt ti Xi
Historic District: /1/0 Zoning: Value of Work: 0
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS 2-0 O Addition/Alteration x Change of Service Temporary Pole % C
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 #:
Owners Name & Address:
Attach Proof of Ownership & Legal Description)
Phone: 30 Z — /6 94
Contractor Name & A dress: -"'0L-Vrt7 C+YZd--C
Z PaZt_ ate License Number -
Phone & Fax: — 3-22_/JZ Z. 3 3'9'7 a& QCuntact Person: 'hone:
Bonding Company:
address:
Mortgage Lender:
Address:
rcnitect/Enetneer:
rare?s:
Upjiumion is .ereay made to „Drain, a re"Nin ti) L'U MC WOO :na ,':.tzilations r..tic:c4. :e.^.1:":11: ^U '.•)n: Jf IGSi 112I10:1 i:15 _ , :1:fICCCI' ^:7Jf CJ .'.
suanc:: of :. cC.-mit ana Gnat Cii 'work 'ail be Cen Jrmea w meet !;mnaara5 UI 4:1 ]aWS fdematta; construction in in1S IUflSalcgUn. , ,:nd:'rSTana l:ial a separate
Jermit imust be securea for ELZC T RICAL 'iVORK. ?LUMBING. -IGNS. ',YELLS, ?OOLS, : URNACES. 301LERS. HEATERS, TANKS, ana
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
Signature of Owner/Agent Date
of Florida Lien Lava FS
5'
of Contractor/Agent Date
4_e4 X/' 69,
Print Owner/Agent's Name P 'nt Co tractoriAgen['s —
aJ
Signature of Notary -State of Florida Date S' true of Notary -State kylorida Date
Owner/Agent is _ Personally Known to Me or Contra * e ora,
Produced ID _ Pry 0 23, Z0084
uuyel c ry setvim
APPLICATION APPROVED BY: Bldg:
Special Conditions:
Zoning: Utilities: FD:
Initial & Date) (Initial & Date) (Initial &Date) (Initial & Date)