HomeMy WebLinkAbout109 E Coleman CirPermit #:_
Job Address:
CITY OF SANFORV PERMIT APPLICATION
RECEIVED
Date: � �` � �—� �� f1l—r' .t !+ 2005
%WLD scription of Work:
Historic District:
Zoning: Wahmof Work: S
Permit "Type>dBu' ing 1/'�' Electrical Mechanical Plumbing 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 Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential # of Water Closets 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#:��- (Attach Proof of Ownership & Legal Description)
Qwifers Nat�i&ddr - A
Phone:
,,gaCoutractor Name & Address: `_�lv '' { iiW 3 (/U
d x"/ State License Number:
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Phone & Fax: -q6;7— �.q I _ ?<``€°, - Contact Person: I� 171.94- �l ��I 'd !a _Phone: _5 7�
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: #ID�%I Y��Y L1i((��t��t� {� Phone:
Address: z-144,0 w14h)Crm)1J 1A) � Vi�i�s{�i0�� '��"���`�.��'� 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 Taws 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: 1 certify that all of the foregoing information is actuate 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.
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Acceptance of pernit is verification that t will notify the owner of the property of the requirem&IFS13.
S ature of Owned aent e Dat Signator of Contr Ftor/ gent Date
q �j
Pi 'tjOwlner/Agent's Name % riot C n tor/Agent's Name
Sig o ota - to e of Flo a Dat Signature of Notary -State of Florida a e
GAFIGi.YI`1 �tl. VAUGHAN
L/ y 6,6
o°Plotary rublic. State of Florida YOwner/Aeent is Personally K owe -My cornrn. expires JUIy 5, 2C#� iractor/Agent is Personally Kno Y or ROSQ Maria Perez Pg11t0)q
Produced 1D No. DD 197607 Produced ID ��O lfF �� 3 £ :: NOZ4 fi$s10N-# DD167947 EXPIRES
=a' November 30, 2006
BO c HRUTROY FAIN INSURANC�INC
APPLICATION APPROVED BY- Bldg.- ' r 1 Zoning: Utilities: FD:
( nitial & Date) (Initial & Date) (initial & Date) (Initial cX Date)
Special Conditions:
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ROBERT Y WHITE, P.E.
PROFESSIONAL CIVIL ENGINEER
FLA. CERT. #13191
407-497-0566 RYWPE@YAHOO.COM
COMMERCIAL. INSTITUTIONAL SITES:
SUBDIVISIONS. RELATED GEOTECHNICAL (SOILS.
SEPTICS); DRAINAGE PLANS: WATER AND SEWER
EXTENSIONS: LIFT STATIONS. RESIDENTIAL
AND MARINE HURRICANE CERTIFICATIONS.
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() APPROVED BY
DATE Z. REVISED
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