HomeMy WebLinkAbout2420 S Elm AveCITY OF SANFORD PERMIT APPLICATION
Permit # :_ 05 ' o J ,7 Date: 3- 1(O " J
Job Address: 7-4 21"% <ChlP4a F I -M A09 .
Description of Work: 3WHQOON, Ablk nt4
Historic District: Zoning: Value of Work: S
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Permit Type: Building Electrical Mechanical Plumbing W111 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 _ # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets _ Plumbing Repair — Residential or Commercial _
Occupancy Type: Residential -- A— Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: (
Attach Proof of Ownership & Legal Description)
Owners Name & Address: -j4
L 321 tiKl `
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State License Number: C FC o,
Phone & Fax: y 7-(Pf- r-19t O • i0] Z11 TOrj( Contact Person: Phone:
Bonding Company -
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Phone:
Fax:
Application is hereby trade 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, CONSU JW ITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
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NOTICE : In addition to the requirements of this permit, there may be additional restrictions is ope that ay be four in the public records of
this county, and there may be additional permits required from other governmental entities such as water management istricts, state ag ties, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requiremen f Flori ten La , S 713.
Signature of Owner/Agent Date igna re of Con /Agen
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is -
Produced ID
Personally Known to Me or
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions:
Zoning:
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Print Contractor/Agent's Name
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i re of Notary -State of Fl da , Date
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O ANN M. JONNSOIy
Contra gent is
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Produced ID
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Initial & Date) (Initial & Date) (Initial & Date)