HomeMy WebLinkAbout1401 W Seminole Blvd (8)�( �( CITY OF SANFORD PERMIT APPLICATION
Permit #: ` Date: 42 '
Job Address: /4/b/ t�f. St= rl i �loC J3 (, , S ,✓ G��� T—� �Z /�
Description of Work: 2� ccr Si J vel o �✓ .� r Sr
Historic District: Zoning: Value of Work: $ 2�
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 New (Duct Layout & Energy Calc. 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 #: Z S - t �' -3 S-4 "7 (Attach Proof of Ownership & Legal Description)
Owners Name & Address: nnP G -fl- "--�r•' 1--(� =� `� 2t Co---? �-- ,— cZ
es�
._J -L%71 5-P- Phone: c�r� 7 — 3 Z
Contractor Name & Address: -1 �� sem' L-6 s�
-7Z-7 2 `f State License Number: 'fol
Phone &Fax: '3�i� ._� 7 3 I �60 :�:K -736 P" OContact Person: Phone: '3Y�-- �' `�' 4� 7
«Bonding Company:
Address: Ej
Mortgage Lender:
Address: ULU ((yy
Architect/Engineer: __ 0 Phone:
Address: ' ' : Fax:
Application is hereby made to obtain a permit to do the work"and ins 11 i s 1 a e . I fy hat no work -or installation has commenced prior to the
issuance of a permit and that all work will be performed Co meet stan s a 1 I s r ti g traction -In this jurisdiction. I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SI S, ' L ACES, 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
constniction 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 requirementtss' of
Florida Lien Law, FS 713.
la o L(
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name Print Contractor/Agent's Name
/,0,/0)0y
Signature of Notary -State of Florida Date gn e of Notary -State of Florida Date
DEBBIE BLANTON .
Owner/Agent is _ Personally Known to Me or L�scOMMS610kafi)MOMft,� e,or
Produced ID LXPIRESFebruan 25, 2007 FI_ Notary Discount Assoc. Co.
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APPLICATION APPROVED BY: Bldg. [ b Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
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US 17 & 92, SEMINOLE BLVD.
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