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HomeMy WebLinkAbout2418 Holly AveT R CITY OF SANFORD PERMIT APPLICATION ( Per nit # Date: / / Job Address: Description of Work: U ' Historic District: Zoning: Value of Work: $r'1 d O 0 Permit Type: Building lectrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole Mecbanical: 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 Wate losets 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 #: Ow1&rs Name & Name & I Phone & Fax: Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Address: Contact Attach Proof of Ownership & ego] De rption) Ph r tat ce ber: C C C - Phone R S 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 ents of F] Li 13. Signature of Owner/Agent Date Signature of Contructor/Agent Date Print Owner/Agent's Name Pri ontracto Agent's Name J Signature of Notary -State of Florida Date Signat of-State190gp$LANTO JMYCOMMISSION * 25 2l]0 EXPIRES: February TARP xoyM Aasoc Owner/Agent is _ Personally Known to Me or Contacc r/v S@ar tH9P " Produced ID _ Pr APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD: Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date) Special Conditions: f Company: Owner AFFIDAVIT REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS 0'6 C- 9 5 6. 70?d3 Project Information Permit M © S' / U y, arp d Subdivision: address y a'V1Lot #: phone lv' ze 111 1 affiant, hereby affirm that I am the duly licensed contractor of record for the above referenced permit, that all the foregoing information is true and accurate, and that the dry -in, flashings at the above referenced address or lot has been installed in accordance with the applicable codes and standards. Contractor: a g signature printed name STATE OF FLO A COUNTY OF nn This instrument was acknowledged before this r y day of "` , 2Q S by the above referenced individual,uct' cr J , who acknowledged that he/she is a duly licensed contractor with an ks-acknowledged that he/she was authorized to execute this document. He/she is either rsonally known to or produced as valid iden ' ica ion. WITNESS my hand and seal this T day of _ 0-c,, , 200 ut Q_ Notary Public