HomeMy WebLinkAbout3375 Mellonville AveCITY OF SANFORD PERMIT APPLICATION
Permit #: i
Job Address:
Description o
Historic Distr
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole _
Mechanical: Residential --k/— 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 'V' Commercial Industrial Total Square Footage:
Construction Type: # of Stories: L # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address: _ L e o * R U fh A
Attach Proof of Ownership & Legal Description)
Phone: _
ConnttraacctorGN`ame&Addreess: FiatCtfiYls e[ fs/C 4i wt.T 305- Sf. ToAAI R14,4'
SI FO A 0 t 4 State License Number: a /4CD b0q 3Y
Phone & Fax: N07- 37.2 - 7ySS- 317- 3255 Contact Person: RO D Fig C SZXMpr2^Phone: C/D') - 32'-L VS
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
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 HAYING
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 found in the public records of
this county, and there may be additional permits required from other governmental entities such as water management
di771'3.
to agencies, or federal agencies.
Acceptance of permit is verification that 1 will notify the owner of the property of the require is of F da Li
Signature of Owner/Agent Date Signature of Contractor/Ag Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg: Zoning:
Initial & Date)
Special Conditions:
Initial & Date)
Utilities:
s Name
W
DEBB119 BLANTON
MY COMMISSION # DD 18N91
EXPIRES: February 25, 2007
FD:
Initial & Date) (Initial & Date)