HomeMy WebLinkAbout400 Locust Ave (2)c' /
CITY OF SANFORD PERMIT APPLICATION
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Permit # : o OV m m 1' 1a Date: lD
Job Address:
Description o!
Historic District: Zoning: Value of Work: $ .1t9Uo
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: Nh w Service — # of AMPS ddit' 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
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 `]Ca /1`y
qon ti0 f Le>- {lD Phone: _._--
Contractor Name & Address:
Phone & Fax:
r
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
State License Number: t_/'t C-U3 6 8
Contact Person: Lr—rl i t Phone:
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and insaalstions as indicated. I certify that no work or installation has commenced prior to the
issuar-tee 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 YM;R 1'A'r ING
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.
Acceptance of permit is verification that I will
Signature of Owner/Agent
Print Owner/Agent's Name
Signature of NotaryState of Florid
notify the owner of the property of the requirements of Florida Lien La
nL, Ft3.
31(11, y'
Date Signature of Contractor/Agent :ate
nn actor/Agent's/
Namrr
laDateiateofFloiaDate
Owner/Agent is'— Personally Known v, Me or
Produced ID
APPLICATION APPROVED BY: Bldg:
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Zoning:
Initial & Date)
Special Conditions:
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Co^!ractor/Agent is; _• ponaliytK/rRi OWNdON
ProaucedID. t°' f,()A4A4}8SI0M#-ljBZgN
EXPRES: Pdarch 23, 2008
9udge 2ary Seri
Initial & Dare)
Utilities: I) ICES
Init al &: Date) (Initial & Date)