HomeMy WebLinkAbout2429 Bay AveCITY OF SANFORD PERMIT APPLICATION
Permit # : 0 5 - `/d 10 Date:
Job Address: c-) RVQ_
Description of Work: R`"t "`e'
Historic District: Zoning: Value of Work: $ 5W' "5:)
Permit Type: Building Electrical ALI Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential %C 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
Occupancy Type: Residential Commercial Industrial _
Construction Type: # of Stories: # of Dwelling Units:
Plumbing Repair — Residential or Commercial
Total Square Footage:
Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: GY< L n1vr P.D, 12, ado 5ti or.T r a
Phone:
Contractor Name & Address: fir' L" l L'k `'C"i L13o LJoi- Dry Prl -} Se".1 ,;W Y1 3a c'a ion
Sate License Number:
Phone & Fax: LW-r)3a-3051 %+ 11by `18B-o3 1 Contact Person: 4/y ' C Phone: SS "=-
Bonding Company:
Address:
Mortgage Lender:
Address:
N4
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 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 maybe additional restrictions applicable to this property that maybe found' the ublic records of
this county, and there maybe additional permits required from other governmental entities such as water management districts, state age ies, r federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requQmenofFlori Lie Law,FS713. 3jos
Signature
of Owner/Agent Date Signature of Contractor/Agent Date Print
Owner/Agent's Name Print Contractor/Agent's Name a
111141" "A Signature of
Notary -State of Florida Date gnature of tary-State of Florida Date Owner/Agent
is - Produced ID
Personally Known
to Me or APPLICATION APPROVED
BY: Bldg: Initial & Date)
Special Conditions:
Zoning: Ay
06
Jennifer A Eakin My Commission
DD080390 Contractor/Agent
ik Person4ij,, i4i 0&ge45F8pruary 8, 2008 Produced ID
Initial & Date)
Utilities: FD:
Initial & Date) (
Initial & Date)