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Permit #
Job Address:
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date:
Q a AJAR to ILW kwX \
ar, Zoning: Value o Work: $ (. Q (D t CA— NO 1)
Permit Type: Building Electrical echanical Plumbing Fire Sprinkler/Alarm Pool
r
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Tempotary Pole
Mechanic .Residential Non -Residential lacement 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 T e: Residential Commercial Industrial Total Square Footage: '
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: Q t A 0 ' S7 ' 1 )
Owners Name & Address: Y1
t
t C. %. 4
Contractor Name & Address: Da t— l ng— \cQ CDyVIVI
Attach Proof of Ownership & Legal Description)
t- -
Phone: Curl) Fa3 Gqc 3
Co C -A274 6 State
License Number: l' W_L05A41111 2S TN;
WL-& Fax: L o1, 333.3853 Contact Person: h Phone:r\ 07 l),( 6' Bonding
Company: WV0, Address:
Mortgage
Lender: 1\4l r'L Address: Architect/
Engineer:
Phone: Address: 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 perforated 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 YOUI 17A WJ\KP 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 govemmental entities such as water management dis state a r federal agencies. Acceptance of
permit is verification that I N%ill notify the owner of the property of the requirem o F ien 13. 3 a
o5 Signature of
Owner/Agent Date ature of Contractor/Agent ( Date Robei-t
0, - C o k 0 c.-SSc) Print Owner/
Agent's Name ` 101 ontraclor/
A
is vame JI
M1
Vk
C,- /C).LJ Signature
of
Notary -State of Florida Date Signature of Notary -State of Florida Date Owner/Agent
is _ Personal] Known to Me or Produced ID
APPLICAI ION
APPROVLD BY: Bldg: Initial & Date)
Special Conditions:
S3 , co
Zoning: Contractor/
Anent
is kPersonally Known to Me or Producec ID
Initial & Date)
L:::aies.
FD: Initial & Date) (
Initial & Dated r MIRINDACTURNER
MY
COMMISSION
li DD 212893 A EXPIRES:
June 14, 2007 1? , Bonded
Thru Notary Public Undernr4e13