HomeMy WebLinkAbout1270 Updala Executive CenterCITY, OF SAN ORD P
ERMIT APPLICATION
Permit # : r Co' CJ �� - \ �O �j J 3 Date. A- c5d
Job Address: l ,camlyT- »j-rs�cP.
j Description of Work., 11�1t .� N1 wyi-tc�-t�uNc� t^lsa c ut.}
Historic District:
Zoning: Value of Work:
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm D�. PoQI .
.r
Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Gall. Required)
Plumbing/ New Commercial: # of Fixtures It of Water & Sewer Lines # of Gas Lines —T
Plumbing/New Residential: # of Water Closets Plumbing Repair - Residential or Commercial
Occupancy Type: Residential Commercial 9"'-> Industrial _ Total Square Footage:
Construction Tyne: # of Stories: # of Dwelling Units: Flood Zone: (FEMA forut required Cor other than X)
Parcel #
Owners Name & Address: VP'a').bj -t' - .t r rte of r -L alafg _-
i.a
(Attach Proof of Ownership & Legal Description)
Phone:
Contractor Name &" Address: &Am FL' ,00 Fq.
311 Fist -Wt "n -act 1Jxvi� State License Number: ZSC1411002 t t Q�►c��
Phone &
Bonding
Address:
`Tortgage Lender:
Address: _ F
Architect/Engineer: +i f ` A�0" + Phone:
Address: _,.... Fax: --
Application is hereby made to obtain a permit to lathe work
issuance of a permit and that all work will be perforrWg.to m
permit must be secured for ELECTRICAL WORK, PLUMB
AIR CONDITIONERS, etc. '' '
certify that nd work or installation has commenced prior to the
ng construction in this jurisdiction. I understand that a separate
FURNACES, BOILERS, HEATERS, TANKS, and
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 FAILURETO 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
A'[TORNEY 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 agrncies.
Acceptance of permit is verification that I will notify the owner of the property of the require of Flori a Lie Law, FS 713.
Signature ofOwner/Agent Date Signa urc .Oniracr /Agent Date
Print Owner/Agent's Name Prig ContracAgent's Name....................................�..�........�
JENNIFER VU
U,SCbFtrhtission # OD0191266
Sig*rtature of Notary -State of Florida . Date Si: n cure of�01
y -State of Floid = ff Da``Expires 3/9/2007
Bonded through
(800.432 A254) Florida Notary Assn., Ino.
i...•......4 ................. 0.... 4.................i
Owner/Agent is l'ersonalh Kno%rn to rile or Coni-actor/Ag,-r.: i
Produced tD Pfoduccl .D
MYLICA CION APPROVED BY: Bldg: 1 1� _ `Coning: _
(Initial &Date) (Initial & Datel
Spccia! Conditions: _
\\ 1"� J _QC)