HomeMy WebLinkAbout220 Bradshaw DrCITY OF SANFORD PERMIT APPLICATION
Permit # : (_, S_ 1 (2
Date: SWa '1'l 5
Job Address: _ 210 git:wos ks w l @ ff
Description of Work: -,aaw auwc— w 1 sec; $(oGgL
Historic District: Zoning: Value of Work: S $ 9 6 • ' 1
Permit Type: Building Electrical Mechanical Plumbing —'-- Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential ./ Commercial
Construction Type: # of Stories:
of Water & Sewer Lines # of Gas LZR:esidentiNalrPlumbingRepair Commercial
Industrial Total Square Footage:
of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 3S 10, 3o S •Z.-X_ 0 Doo O 1-1 O (Attach Proof of Ownership & Legal Description)
Owners Name & Address: 2ivsh.,scm:% Pi C. L20 $Qqp S1lsir_t bit. srla'oa. 32'11(
Phone: 461.322- 4318
Contractor Name & Address: Mt etksmuL 244 6">r C 1 4t_
1AO OtEI C—MMMAIL-4 bt2t.k '3Z,g0-7 State License Number. G'N•G 1411.3'10
Phone&Fax: "-I. YI9.22o Contact Person: Nltu4%4&L nti0. Phone: At L1a"
Bonding Company: --
Address: I'' I A
Mortgage Lender:
Address: A
Architect/Engineer:
Address:
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 regulatingconstructionandzoning. 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 requirements of Florida Li
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
In*
t Contractor/A ent's me
ignattrre of Notary a of lorida Datev7s
Contractor/Agent is C Personally Known to Me or
Produced ID
1 _ z `7APPLICATIONAPPROVEDBY: Bldg: WM Zoning:
Initial (Initial & Date)
Special Conditions:
Utilities: FD:
initial & Date) (initial & Date)