HomeMy WebLinkAbout1807 S Palmetto Ave (3)CITY OF SANFORD PERMIT APPLICATION
Permit # :
Job Address:
Description of Work:
Historic District: Zoning: — Value of Work: $ :k 1 a C7 v
Permit Type: Building Electrical
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Mechanical Plumbing Fire Sprinkler/AlPool lteratio —
Addition/An Change of Service Temporary Pole Replacement
New (Duct Layout & Energy Calc. Required) Plumbing/
New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines Plumbing/
New Residential: # o7OCommercial Closets
Plumbing Repair — Residential or Commercial Occupancy
Type: Residential Industrial Total Square Footage: Construction
Type: # of Stories: 4— # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #:
Owners
Name & Address: Contractor
Name & Address: Phone &
Faz: Bonding
Company: Address:
Mortgage
Lender: Address:
Architect/
Engineer: Address:
Attach
Proof of Ownership & Legal Description) Phone:
State
Lice se Number/ c
Contact
Person: Phone: C %/ —Pe 14 Phone:
Fa::
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. NOTI
E: 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
t is verification awt I will notify -the owner of the property of the requ' f Florida Signature
of Owner Date Signature of Contra 7Print
Owner/Agent's Name Print Contractor/Ae Signature
of Notary -State of Florida Date 1
Owner/.
Agent is _ Personally Known to Me or Produced
ID APPLICATION
APPROVED BY: Bldgj 94-QL_h Q I I n Wig: Initial &
Date) Special
Conditions: Initial &
Date) 7. ,
FS 713. Date
Name
L
T-
Statb 1fLANTON MY
COMMISSION # DD IS Mt EXPIRES:
Fpuruary25.2007 Utilities:
FD: Initial &
Date) (Initial & Date)