HomeMy WebLinkAbout400 S Locust StCITY OF SANFORD PERMIT APPLICATION Ii
Permit # 05
Job Address:
Description of Work:
Historic District:
L. 1
Date: Q y/ !ID 10.
Zoning: Value of Work:
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 Water 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)
Parcel0:
Owners Name 4
Attach Proof of Ownership & Legai Description)
Phone:
Contractor Name & Address:
State License Nun^_'>•er:. C C
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Contact Person: Phone:
Phone:
Fax:
Application is hereby made to obtaiii 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, iavis mgulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MA`.' RESULT IN YOUR PAYINGTWICEhORIMPROVEMENTSTOYOUReROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER O:t 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 notify the owner of the property of the requirements of Florida Lien
Signature of Owner/Agent
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is'_ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg: Zoning
Initial & Da )
Special Conditions:
Signature of
ContracLNa
Date
rS a n
Pri t C tracto ' \
Or t D 10
matureN)fl p[aq- p t rida Date
ft RtNC A. DE GRAVE
MY ISSION # DD 164281.
P IR November 12, 2006qr o
Contract6i%Aj nt is Me or
Produced ID
Initial & Date)
Utilities: V_
FD:
Initial & Date? (initial & Date)