HomeMy WebLinkAbout1201 Upsala Rd (2)R. 01a k
CITY OF SANFORD PERMIT APPLICATION FEB 16 2006
Permit # : C)U — t s �a o I i Date: co
Job Address:
Description of Work:
Historic District:
(•e WL its 44*10K
Zoning:
Permit Type: Building Electrical
Electrical: New Service-# of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
N
Value of Work: $ t tivo
Mechanical Plumbing Fire Sprinkl /Alarm ( Pool
_ Addition/Alteration Change of Service Temporary Pole
_ Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair - Residential or Commercial
Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Pa reel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: Z) C -Ia cm -t Son -s
Phone:
Contractor Name & Address: SekV7f-Wte Lc -t— 94 4 ` «"s S
if o (fe A cV, c. CA r..c l7.en.4 / 1 / State License Number: CV CPO
Phone &Fax: 3-3 Contact Person: A tc(l 70<4-vKt � Phone:
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. 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: 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 pen -nits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit is verification that 1 will notify the owner of the property of the requirements of Florida Lien Law, FS 713
Special Conditions:
T I M
14% -�,,' (&'(i (�-
Signature of Owner/Agent Date
Signaatr ureoff/Contrac.toor/Agent Date
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Print Owner/Agent's Name
Print Contr efil A is Name
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Signature of Notary -State of Florida Date
Signa ure FiE GFWJE Date
* vlY COMMISSION # DD 164280
EXPIRES: November 12, 2006
?hrecarvice.
Owner/Agent is Personally Known to Me or
Produced ID
Con ctor/Agent is Personally Known to Me
`Produced ID Ay(b - kygq - US ' kp''
APPLICATION APPROVED BY: Bldg: �' 13
Utilities: 3 Z FD:
(Initial & Date)
(Inina & ate) (Initial & Date) (Initial &pate)
Special Conditions:
T I M
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PAC
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REVIEWED
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Sanford Fire P ev Div. CITY OF SANFORD
PERMIT#Ckwv-pl.tPO
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