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Home My WebLink About119 W Woodland DrCITY OF SAN FORD PERMtt APPLICATION Permit # `-`- Date: Job Address ' i (•(� G�Jc1;�17( l� J�� <S:A- Fu ✓t0 (= L Description of Work: J:�S -7A) ! n �� 6, 0 2lq Historic District: Zoning ''Value of Work: J 00, Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarut Pool Electrical: New Service — # of AMPS _ — Addition/Alteration Change of Service Temporary Pole Mechanical: Residential Non -Residential 'l ]llc nt New (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: # of Fixtures # of'u'da rh-Sewer Lines It of Gas Lines Plumbing/New Residential: # of Water Closets A,,• Plumbing Repair— Residential or Corritnercial Occupancy Type: Residential Commercial Industrial Total Square Footage: . r Construction Type: # of Stories: �# of Dwelling Units: Flood 'Gone: (FEMA form required for other than X) Parcel #: (Attach Proof of Ownership & Legal Description) ,Owners Name&Address: Contractor Name & Address: d S b�,r'/a % r'/I CZ ,4- Z 0 15 I �() G 2.2- Slate License Number: (!_0 13 �✓63 I'iioue Sc Fax: (?r�C % ` _ ,3 ' / I / Contact Person: D19I � _ � ; 1 Phone: �/ O%- �� 2 � C�• ? %�� Bonding Company: Address: Mortgage Leader. Address: /11 J '� �' % f/ •0 6%�% fi�2 j� Architect/EngincerPhone:: / � it •� ,�, 1 Address: C T rt i )7 /1 as "L � f1 ., O 2n -�S c' C , r Fax: SY6 " VV — JZ S 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. I understand that a separate permit trust be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, IIEATERS, 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 ORAN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE: In addition to the requirements of this this county, and there trey bXditional pennits Acceptance of permit iIS Signal r of C i Print C d SignatuofNt Owner/Agent is X Produced ID I nay be additional restrictions applicable to this property that may be found in the public records of other govertunernal entities such as water management districts, state agencies, or federal agencies. he owner of the property of the requirements of Florida Lien law, FS 713. Date Signature of Contractor/Agent Date Print Contractor/Agent's Name AR at`a., VAR��rt�s� Signature of Notary -State of Florida Date CQEXp RES 09105ISSION 12 0606 CON©EL)THRW t�ealuorA33�^1 own to Me or G>-� zO c''•U,17 APPLICATION APPROVED BY: Bldg1" / Zoning: (Initial & Date) Contractor/Agent is _ Personally Known to Me or Produced ID 1:Iuta (Initial & Date) Utilities: (Initial & Date) Initiak' c Special Conditions: f % _ I - " <- V J e _C` } 1 / 1- I- 4 --v " `--v Je/n e/Z