HomeMy WebLinkAbout807 Volencia StV, CITY OF SANFORD PERMIT APPLICATION
Permit # 6 — / 0
XDescription of Work:
Historic District:
Date: C) / / 19 0S
Plumbing/ New Commercial: # of Fixtures # of Water &'Sewer Lines # of Gas Lines
Plumbing(New Reside ' of Water Closets
OccupancyTyp ResidenCommercial Industrial Construction
Type: # of Stories: # of Dwelling Units: _ Plumbing
Repair — Residential or Commercial Total
Square Footage: Flood
Zone: (FEMA form regetlred for other than X) arcel #: (
Attach Proof of Ownership & Legal Descriptiou) Owoera
Name & Address: Phone:
Address:
Mortgage
Lender: Address:
Architect/
Engineer: _ Phone: Address:
Fax: Application
is hereby made to obtain a permit to do d tall ted. I certify that no work or installation has commenced prior to the issuance
of a permit and that all work will be perform f 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, them 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 requi ts f rida Lien Law, FS 713. ot
Signature
of Owner/Agent Date Signature of Contractor/Agent 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: ,) 1 13 0 S Zoning: Initial &
Date) Special
Conditions: Initial &
Date) l3-
US Ntate
c I". JOHNSON 6ate MY
OMMISSION I DD 2022 EXPIRES:
March 23, 2008 fiNfi:
OY 8 d Thru ut Notery Sery s 1D
ona
owm to a or Utilities:
FD: Initial &
Date) (Initial & Date)
3
ic
I