HomeMy WebLinkAbout200 N Holly AvePermit # : 05-- l
Job Address: 0 0 O j l G L L
Description of Work: N .66Wt
Historic District: Zoning:
Permit Type: Building Electrical
Electrical: New Service — # of AMPS
CITY OF SANFORD PERMIT APPLICATION /
Pate: I A I 0
4C- —4/ A roV, +.t
of Work:
Mechanical Plumbing i/ Fire Sprinkler/Alarm Pool _
Addition/Alteration 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 #:
Owners Name &Address:
xJ a 0 O /V d O L L
Contractor Name & Address:
9 P (_ r= L
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
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Attach Proof of Ownership & Legal Description)
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late License Number: ``//
Contact Person: J G%/ Phone:7o -7
Phone:
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 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.
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 requir ents Flori ien Law, FS 713.
Signature of Owner/Agent Date ature of Contra to ent Date
Print Owner/Agent's Name _:p Print Contractor/Age tme Signature
of Notary -State of Florida Date Owner/
Agent is _ Personally Known to Me or Produced
ID APPLICATION
APPROVED BY: Bldg: F ` I,' Zoning:
Initial & )
Special
Conditions: Initial &
Date) ture
of=.+i65 ate Date M
MMISSION # 00 285622 EXPIRES:
March 23, 2008 r
POQ Bonded Thru Budget Notary Services or/
Ag "ViV Pers a y Known to e or ProducedID
i `l Utilities: lag
Initial & Date) (
Initial & Date)