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CITY OF SANFORD PERMIT APPLICATION
Permit # :
N/ C ./_
u -1 `I—h C Date: 7_Or
Job Address: J #,
Xk
Description of Work: S45TA/1 L,;e1,7S — F NS V X/dAeCp*' tod•S•
Historic District: 0 Zoning: Value of Work: t00
Permit Type: Building Electrical X Mechanical Plumbing Fire Sprinkler/Alarm pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary PoleMechanical: 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 A
Occupancy Type: Residential Commercial Industrial
Construction Type: # of Stories: # of Dwelling Unfits:
Parcel #:
Owners Name & Address:
Plumbing Repair — Residential or Commercial
Total Square Footage:
Flood Zone: (FEMA form required for other than X)
Attach Proof of Ownership & Legal Description)
rx / 761
Mr-L Z5 1777-- 1711
t Phone:
Contractor Name & Address: frt, 97—d 47c, /, fix
State License/Number: G'C a' /--ky
hone -k Fax: _5k,17-3ZZ 1SCZ 3Cjntact Person: ?hone: 107- 9//7-O?I7 3ondingCompany: Address:
Mortgage
Lender: Address:
Architect/
Engineer: y 'hone:
Address:
ax:
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 Ute issuanceofapermitandthatallworkwillbeperformedtomeetstandardsofalllawsregulatingconstructioninthisjurisdiction. I understand that a separate PermitmustbesecuredforELECTRICALWORK. PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIRCONDITIONERS, 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 constructionandzoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICEFORIMPROVEMENTSTOYOURPROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFORERECORDINGYOURNOTICEOFCOMMENCEMENT. NOTICE
In addition to the requirements of this permit, their may be additional restrictions applicable to this property that may be found in the public records of thiscounty, 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 1 will notify the owner of the property of the Signature
of OwnedAgent 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 Bonin g Initial
ate) Special
Conditions: of
Florida Lien 7
got• Si
tore of Contractor/Ag t Date WContmc-
tor/
Agont's N e h (
1 Notary -
State of Flo Date r.,
JO
ANN M. JOHNSON MY
COMMISSION i# DD 2W2 Contractod
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pIREM5Mi23,
2008 Produced'
7D illd y 9 igiMe or Initial &
Date) Utilities:
FD: Initial &
Date) (Initial & Date)