HomeMy WebLinkAbout315 S French Ave (3)Permit It
Job Address:
CITY OF SANFORD PERMIT APPLICATION
.Date:
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Description of Work: y1l`7-t"P-ltt4A IAV' v J /`V
Historic District: Zoning: Value of Work: S 000
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 Replacement X New ^ (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: It of Fixtures It of Water & Sewer Lines It of Gas Lines
PlumbingfNew Residential: It of Water Closets Plumbing Repair — Residential or Cotntncrcial
Occupancy Type: Residential I Commercial x Industrial "Total Square Footage: ' o1)y
Construction Type: If of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:J/� `IU,/t t✓ ��'� J tG (Attach Proof of Ownership & Legal Description)
Owners Name & Address: C�vI Sal `I r Wej U'r 5 r G— & r /
i_ Phone:
Contractor Name & Address: IC�1ctrv; :� 'AlrC1JYl�/�'IbbA" r— [4e0, L /YV / j�
State License
Number: CAA' 0 I � � (11 9—
Phone & Fax: . ��i1 rl�J 3 i1 LC"l Contact Person: ��U� r t t vl/tLGV��C Phone:
t 4 ` -- (OG
Bonding Company: _
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: 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, t 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 o to ida LL' n� a , FS I3'J—
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name (•Print Contractor/Agent's Naate
\ 1
Signature of Notary -State of Florida Date rS gnature of: otseF ate 4 A* JOHNSON Uate
+ _ k MY COMMISSION # 0 285822
y •�� EX(?IRES: March 23, 2008
rFor•FtoE`� F}anded fhru� r I
Owner/Agent is _ Personally Known to Me or Contractor/Agent I 1/ Persona�titKtl�kte or
Produced ID _ Produced ID
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
(Initial &Date) (Initial & Date) (Initial &Date) (Initial &Date)
Special Conditions:
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