HomeMy WebLinkAbout4639 W 1 St (2)Permit:#
Job Address:
Description of Work: _
Historic District:
CITY OF SANFORD PERMIT APPLICATION
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I K L4 e X( 3 ( K c, wtA i ea eI_ S/K/f -U VIC'W IOCu_11U1-1
Zoning: Value of Work: $
Permit Type: Building Electrical Mechanical Plum Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS ition/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 ResIdentiial: # 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)
W
Parcel N.
Owners Name & Ai
16 3 q
6atractor Name 6
56a 6,
Phone & Fax
Bonding Company:
Address:
Mortgage Leader:
Address:
Arebitect/Eagineer:
Address:
Attach Proof of Ownership & Legal Description)
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 perfornod to meet standards of all laws regulating construction in this jurisdiction. i understand that a separate
pennit 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, then; 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 o Flon en w, FS 713
Signature of Owner/Agent Date Signature of Contractor/Ag _ t,y - Datef
1Mlcl Q_ -R _ 0) c U w,f
Print Owner/Agent's Name Print Contractor/Agent's Name
d /d y/)
Signature of Notary -State of Florida Date Signature o ofy State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg:
initial & Date)
Special Conditions:
Produced -4
e-yV
Zoning: Utilities:
initial & Date)
DEBBIE BLANTON
jj MY COMf.1;3SION # DO 18W1
erscot111SRICaa sa"I A79PIAR
FD:
initial & Date) (initial & Date)
r
Permit
Job Address:
Description of Work: /'C( tvc Y
Historic District: Zoning:
CiTY OF SANFORD PERMIT APPLICATION
Date: •L US
i_
r
Value of
vu+cG L rS
Permit Type: Building Electrical _K__ 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 _)!C_ Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel p: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: C S
Phone:
Contractor Name &Address: .1—I ir 4 21 LED[ l ra,-A IIC'' drd HJS W t/t// 5
State License Number:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engioeer:
Address:
Contact Person: Phone:
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 moat 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 applies a to this roperty that may be found in the public records of
this county, and there may be additional permits required from other govemmental entities such as ter t districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the
requISV
of FI 'en Law, FS 713.
Signature of Owner/Agent Date of 6gtractorazgenr—Date
Print Owner/Agent's Name tractor/Agent's Name
Z /10__Is
Signature of Notary -State of Florida Date 1gna
DEBBIE BLANTON
MY COMNUSSION #I DD 188491
Owner/Agent is _ Personally Known to Me or Contaac / D IRkS: evo in5to v a or
Produced ID TART FL r:o Dmc' ou. Assoc. Co.
APPLICATION APPROVED BY: Bldg:
initial & Date)
Special Conditions:
Zoning:
Initial & Date)
Utilities: api
Initial & Date) (Initial & Date)
R tow
Ar-7 ESOP ComPar-7y
WliffflaW a AWORI, GW/9 44141
OH Lic #16429
February 17, 2005
City of Sanford
PO Box 1788
Sanford, FL 32772
To Whom It May Concern:
Bill Todd and Chris Cochran are able to pull permits under my license in Sanford, Florida.
If there are any questions, please call 216-662-7100 ext. 142 or 1120.
Thank you, L-j , 3 7 w l S S
ohnny L. g
Chief Estimator
7 R.J. Martin Electrical Contracting, Inc.
1
Noia ry- Signature
AMANDA LESKO
Notary Public, State of Ohio
My Commission expires April 29, 2009