HomeMy WebLinkAbout320 E 29 St (3)r
Permit # :( _ )`O`
Job Address:
Description of Work: :Igo AI!C
Historic District: Zonine:
CITY OF SANFORD PERMIT APPLICATION
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Date_ 5
MOM
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 # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of W r Closets 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 #: Oj — 1 1—') V --3 f4 L—C— (J S V S — V CJ 114 (Attach Proof of Ownership & L/e gaI Des
Owners Name & Address: AA T C < D A/
Phone:
Contractor Name & Address: A IN r- .04-S BD t
State License Number:
Phone & Fax: Contact Person: Phone:
Bonding Company: i!O
Address:
Mortgage Lender:
Address:
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 ofthe 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.
verification that 1 will
Y Signature of Owner/Agent
the owner of the property of the requirements of Florida Lien Law, FS 713.
FLORENCE A. DE GRAVE
MY COMMISSION # DD 164280
EXPIRES: November 12, 2006
APPLICATION APPROVED BY: Bldg:
Date)
Special Conditions:
Date Signature of Contractor/Agent Date
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Contractor/Agent is,
Produced ID _
Utilities:
Initial & Date)
Personally Known to Me or
FD:
initial & Date) (Initial & Date)