HomeMy WebLinkAbout904 S Elm AveJ.
CITY OF SANFORD PERMIT APPLICATION
Permit#: O`J _ 1S Date:
Job Address: c7 • ,0 L i K Urir
Description of Work. - I' VVTb Rukkl e n Historic
District:
Zoe Value of Worlt: S 21 ODD, Permit Type:
Building V/ Electrical Mechanical Plumbing Fire Spriolder/Alarm Pod FJectiical: New
Service — # of AMPS Addition/Alteration Change of Service Temporary Pole Mechanical: Residential
Nan -Residential Replacement New (Duct Layout & Energy Calc. Required) Plumbing/ New
Commercial: # of Rdures # of Water & Sewer Lines # of Gas Lines Plumbing/New
Residential: # of Water Closets Plumbing Repair — Residential or Commercial Occupancy Typr.
Residential Commercial Industrial Total Square Footage: Contraction Type: _
I # of Stories: # of Dwelling Units. Flood Zone- (FEMA form required for other than X) Pared#: 5 /
7,/ t QO t/ (Attach Proof ofOwoership&Legal Description) Owners Name &
Address: E Hot- I NA&S' 301 rNT 4- 61&
woo D / FG 3 Z 779 Phone: #f 7- 78& - zlZS'hS Contractor Name &
Address: EUQie f f $OL/ // 0"S77e1,(C T7 iYQ MIC 180 S, "
AW-D Stator Lieeose Nsmber: C60 01517 -35, Phone & Fas
IM /— U tar 6 / 7/ Contact Person: Xg5>CX-A - 4 r- /'O/c C' Phone: Bonding Company:
Address: Mortgage
Leader:
Address: Arebitect/
Eogioeer:
Phone: Address: Fax:
Application is
hereby made to obtain a permit to do the work and insulations as indicated. I catify that no work or installation has commenced prior to the issuance of
a permit and that all wok will be perfumed to moat standards ofall laws regulating construction in this jurisdiction. I understand that a separate permit must
be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, FOOLS, FURNACES, BOILERS, ]HEATERS, TANKS, and AIR CONDITIONERS,
etc. OWNER'S
AFFIDAVIT: I eat* that all of the foregoing information is accurate and that all wok will be done in compliance with all applicable laws regulating construction and
wring. WARNING TO OWNER YOUR FAILURE TO RECORD A NOTICE OF CONNIEN(EMENT 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, this county,
and them may be additional permits require Acceptance of
pool is MIICfi 6AFNS'
may be
additional restrictions applicable to ibis property that may be found in the public records of room other
governmental entities such as water management districts, state agencies, or federal agencies. owner of
me propeAy of the rmgo' lorida Lien Law, Date Signature
of Contractor/Ageet Date UDr2 of
NolaryElsms=
V iT
Date
Signature of N•otar)State 47turidaOF DA 5-
We WAN
MUCQ15344
tNOTARY -
STATE OFOItIOAttis0&7o
Contra J.> 15344 1 _ r EXPIRES
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a/
nn kilo: 90NM rpm1&OONOTARYI APPLICATION
APPROVED BY: BI li
Utilities: FD: Initial Da / (Initial & Date) (Initial
dt Date) (Initial B Date) Special Conditions:
CITY OF SANFORD HISTORIC PRESERVATION BOARD
APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
P.O. Box 1788, Sanford, FL 32772-1788
Phone: 407 330-5672 Fax: 407 330-5679
TO: THE HISTORIC PRESERVATION BOARD OF THE CITY OF SANFORD, FLORIDA
0 Downtown Commercial Historic District 0 Residential Historic District
0 This application is filed in response to a notice from the Code Enforcement Department
ADDRESS OF PROPERTY:
Property Owner
Signature: M i l JI.PiNB Print Name:
Mailing Address:
Phone: Fax:-
Applicant/Agent
Signature: Print Name:
Mailing Address:
Phone: Fax:
I certify that all information contained in this application is true and accurate to the best of my knowledge.
Applicant/Owner: Date:
Please use the attached criteria checklist as a guide to completing the application. Incomplete applications cannot be
reviewed and will be returned to you for more information. You are encouraged to contact the preservation planner at
407-330-5672 to make sure your application is complete.
Description of Proposed Work/Application Category: (Check all that apply)
o Site Improvements/driveway/walkway o Storage shed o Moving structures
o Replacement windows or doors o Underskirting o Awnings
D New construction/additions o Signs 0 Demolition
oofs/gutters/downspouts 0 AC/Mechanical o Fences/Gates/Pergolas
o Replacement siding/flooring/porch o Paint o Other
Completely describe the entire scope of work: all changes in material, color or location to the exterior of the building,
where on the property the work will occur and how the work will be accomplished. For large projects, an itemized list is
recommended. Attach additional pages if necessary.
A Certificate of Appropriateness is valid for six months unless otherwise noted
Historic Preservation Board Mee ' Date:
Application is Approved
Conditions:
Signed:
OFFICIAL USE ONLY
Staff Review Date:
Approved with Conditions Denied
Date:
This Certificate must be prominently displayed on the building when work is in progress***
F:\SHA-ENG\Historic Preservation Board\C of A Application.doc