HomeMy WebLinkAbout2601 E Airport BlvdCITY OF SANFORD PERMIT APPLICATION
Permit # •O
Job Address: _!(OO
Description of Work: HCrf
Historic District:
Permit Type: Building,,-' Electrical
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
Parcel #:
Date:
i
Mechanical Plumbing Fire Sprinkler/Alarm Pool
Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. Required)
of Water & Sewer Lines # of Gas Lines
Plumbing Repair — Residential or Commercial
Industrial Total Square Footage:
of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Attach Proof of Ownership & Legal Description)
Owners Name &Address: 5Qf1Vor d Alr i2m -1 Rv4hori iv lZ*D Ked c1eVt_IcL-to1 lSlxrCJ
JOA 32 77 3 Phone: 5V07 S&S- riCOO
Contractor Name & Address: C Or n ann 4ii 1 /Oo L. e n en ex _ , G' ).
L O —,L 307SO State License Number:
Phone & . '/O 7 Va V ^ Sofoc. Contact Person: aOyi n/ M Cr^Q i, Qf3q Phone: __&P I -Z 3 J7
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Phone:
Fa::
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 fe/deeral a encies.
Acceptance of perm' 'verification that I wi notify the owner of the property of the requ' en of Florida Lien Law, FS 713. `
v
zr C 3 -
g
Srgmab& of O_wner/Agent Date Signature of Co/nttrac r/Agent Date
yal iC!!'/ 4, r
G- Am . -t- l('U 1 // M Pi G_ip
U 0 t er/ genCs Name
W60
Z c of Notary -State of Florida Date
Wn2u 0
ao3 6
W= caner/Agent is _ Personally Known to Me or
a Produced ID
APPLICATION APPROVED BY: Bldg: ( oning:
Initial ate)
Special Conditions:
Initial & Date)
Date
MY COMMISSION 4 DD 164280
I EXPIRES: November 12, 2006
htisraoMsCPas llyyoiisps o Me or
ID tv Sd'S'S1 \co
Utilities: FD:
Initial & Date) (Initial & Date)