HomeMy WebLinkAbout795 Vihlen DrCITY OF SANFORD PERMIT APPLICATION
Permit # -. 1' " J
n
Job Address: %q / /
Description of Work: / fo\L Id T o- C
Date: 01 — Zy 0-5-,-
Historic District: Zoning: Value of Work:
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS W ii Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential _
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
Replacement New (Duct Layout & Energy Calc. Required)
of Water & Sewer Lines # of Gas Lines
Plumbing Repair— Residential or Commercial
Industrial Total Square Footage:
of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 3r-7 14-- -3i K — 0860 Owners
Name & Address: _ Contractor
Name & Address: G Attach
Proof of Ownershi & Legal Description) 324-
43(0 -4_3en Phone:
f
U /DX J LLIa 9/ C WV(,..W C?ol ;7 /—ci J e- /7 [, State License Number: Ac Phone &
Fax: y i % JZ 116% e Contact Person: T( /1' Phone: 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 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 govemmental 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 w 713. 4
Zq 67S Signature
of Owner/Agent Date Sign or/Agent Date Print
Owner/Agent's Name Print Contractor/Agent's Name n
Signature
of Notary -State of Florida Date (yinature
of*
t*.-`Statef f• , ' . Date y
Q.
a LION # DD F;: PIRES:
March 23, 200-' M,. rit
taordw ThN OW9et Notary Serviu Owner/
Agent is _ Personally Known to Me or Contractor/Agent is Perso4ll Known to Me or Produced
ID !'Produced ID FW-7 L. L 5(& 32. 3 2-0 APPLICATION
APPROVED BY: Bldg: ` Z
4 Z
oning: Initial ,
ate) Special
Conditions: Initial &
Date) Utilities:
FD: Initial &
Date) (Initial & Date)