HomeMy WebLinkAbout905 Laural AvePermit # :— _ \ 1 l
Job Address:
Description of Work: -C &'4. '
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
A
Date: 3 /q/0
Value of Work:
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS 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:
Parcel #:
Owners Name & Address:
Contractor Name & Address:
Replacement New (Duct Layout &Energy Calc. Required)
of Water & Sewer Lines # of Gas Lines
Plumbing Repair — Residential or Commercial
y Industrial Total Square Footage:
of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Attach Proof of Ownership & Legal Description)
Phone: -j!QD % 3.11 —.113
it 9i,n"- State License Number: L /T L.. a J b d n'
T16 g4w+ ,.
Phone & Fax: 711 Contact Person: USI'1 / -G Phone:
Bonding Company: #44=4517 p M
Address:
Mortgage Leader:
Address:
Architect/Eogioeer:
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 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 requirements of Florida Lien Law, FS 13. /
O
Signature of Owner/Agent Nate 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: Zoning:
initial &
Name
sn ?> 1
a'GRAVE 14
Signature of of y%A"WW 164280 Date
EXPIRES: November 12, 2006
o Thm Budllet Notary ServicesBOo
Contractor/Agent is ersonally Known to Me or
Produced ID
Utilities: FD:
initial & Date) (initial & Date) (initial & Date)
Special Conditions: