HomeMy WebLinkAbout916 Locust AveCITY OF SANFORD PERMIT APPLICATION
Permit # : Date:
Job Address:
Description of Work: \
Historic District: Zoning: Value of Work:
Permit Type: Building Electrical Mechanical Plumbing —111/ Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Ca1c. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets .
4)"'
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 #:
Owners Name & Address:
Attach Proof of Ownership & Legal Description)
Phone: Iky tuWf'
Contractor Name & Address: T H_
aoo L, S.PC.. % Rat; sy,,,14 FL 3c)--71% State License Number: CFCuS7y?-'1
Phone & Fax: ` 0 Q%;3 74 %1 Contact Person: Phone:
Bonding Company:
Address:
Mortgage Leader:
Address:
Architect/Eagineer:
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 ofa pemtit 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 entitieIsuch ter g t districts, agencies, or federal agencies.
Acceptance ofpermit is verification that I will notify the owner ofthe property of the requo en 13.3
1 Signature
of Owner/Agent Date of Conr/ ge Date It
ry 1 Print
Owner/Agent's Name ' Con taacis Name u
S Signature
of Notary -State of FloridaDate Signafti e of N -=onLANTON * DD
1W91ary 25. 2007Owner/Agentis _ Personally Known to Me or Con y t g wto MEoor ProducedIDIN-. APPLICATION
APPROVED BY: Bldg: Zoning: Utilities: FD: initial &
Date) (Initial & Date) (initial & Date) (initial & Date) Special
Conditions: