HomeMy WebLinkAbout2200 W 1 St2
�� <�� " '�'►'i+�c►� '°' CITY OF SANFORD PLRMIT APPLICATION
Permit # JIB Date: 3
,q
Job Address:
Description of Work:-EPJVT—P lI FI`p—e A ARvr- 7`°e— m^
Historic District: Zoning: Value of Work: $ , 4,0, d 1
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/AlarmPool
Electrical: New Service – # of AMPS Addition/Alteration, Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Pluntbing/New Residential: # of Water Closets Plumbing Repair – Residential or Commercial
Occupancy Type: Residential Conunercial Industrial Total Square Footage:�%m&
Construction Type: 006 # of Stories: % # of Dwelling Units: Flood Zone: (FEMA form required fur other than X)
Parcel #: ai / 9a ®a /A "t� d,/ r (Attach Proof of Ownership &eLegal Description)
54)
Owners Name & Address: _ N901FpR f�9 000—d1cK u t7 eVJ -eV' ZZOO I/ ,
Phone:
Contractor Nante & Address: Gu) 'St4S 1 °C 16%S 6 _ �V [ f 76 / /- �'rDf t>L dl �/►i t�Ai
Phone && Fax /�i� %7 3'7J� • jag '%�,4�Cuntact Persou: t !s r8 / �T�Ylwuc:��! �J�/
Bonding Company:
Address:
Mortgage
Address:
Architect/Engineer: _ Phone:
Address: " Fax:
Application is hereby made to obtain a permit to do'di .work and installations as indicated. ( certify tha no' -work or installation has commenced prior to the
issuance of a permit and that all work will be Iseforzried to n7 f" tinda dJAI ljl }w�'Segu at�tg constructoriin this jurisdiction. [ understandthat a separate
permit must be secured for ELECTRICAL WORK; PLUMBI r S,V, PtLUURNACE'S, B)ILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify that all of tli'e foregoing information is accurate and that all work will be�*Ebne 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, CONSULTWHII YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that mr, Y b ound in the public records of
this county, and there may be additional permits required from other governmental entities su s wa n7anage ent district's. to , gencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the re tirement.
Signature of Owner/Agent Date Signature of C tractor/Agent F, Te
Print Owner/Agent's Name
Signature of Notary -State of Florida
Owner/Agent is — Personally Known to Me or
Produced tD
Contractor/Agent's Name
Date Signature
Contractor/Agent is
Produced ID
ofF'IidaN,- BE-PdtMARIEEMMONS
"� MY COMMISSION # DD145724
W EXPIRES: March I6,20W
Perso •Ill 4pF,Yo
y-FIpt1.(}N�1kF79vIeF4ttNvtwy Service & Bonding, Inc.
APPLICATION APPROVED BY: Bldg 5 -1 -(SIC _ Zoning: Utilities:
(initial & Date) k (Initial & Date) (Initial & Date)
Special Conditions:
�0 VT
r,