HomeMy WebLinkAbout820 W 20 St (2)CITY OF SANFORD PERMIT APPLICATION
Permit #: / S - R ,p Date:
Job Address: C ?/a u 4
Description of Work: _ Q42 -d 5( e-C
Historic District Zoning: Value of Work: $ 7 00 • s D
Permit Type: Building Electrical _ Mechanical Plumbing Fire Sprinkler/A arm Pool _
Electrical: New Service - # of AMPS 15fl Addition/Alteration Change of Service Temporary Pole
Mecbanical: 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)
Parcel #: Attach Proof of Ownership & Legal Description)
State License Number: _ C
Phone & Fax.` %:n (e' Q ( Contact Person: Phone: a-71 g
Bonding Company:
Address:
Mortgage Leader:
Address:
Architect/Engiaeer:
Address:
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to theissuanceofapermitandthatallworkwillbeperformedtomeetstandardsofalllawsregulatingconstructioninthisjurisdiction. 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 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 require n f Florida Lien Law, FS 713.
Signature of Owner/AgentSignature-ofI
s
Date Contractor/Agent Date
Print.Owner/Agent's Name
L- 61
Si patu of Notary -State of Florida to
Owner/Agent is Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg: U ICLV.N 3,11 1 V zoning:
Initial & Date)
Special Conditions:
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Print Contractor ent's Name
O'
Si Notary -State of Flo Date
Contractor/Agent is 1Z
Produced ID ,
Utilities:
Initial & Date)
Notary Public State of rie&
I,L&-"y
COrnmission D0388525r,,,..— ---
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