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HomeMy WebLinkAbout1665 WP Ball BlvdPermit # : V� — U c Job Address: Description of Work Historic District: CITY OF SANFORD PERMIT APPLICATION RECEIVED '.5LVWt 14oD1141V Jd �Pc15 Zoning: ' Date: 70©� 206 j��t0�4,ClJ FLS' 3 2 � 11 �Ls(9®c 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 #: Owners Name & Address: / (0 (o S /A/f I y'4NU/q-5 Contractor Name & Address:��� Al Phone & Fax: 46-7- 55)- 6-5-4.4, Bonding Company: Address: Mortgage Lender: Addrrsc- Architect/Engineer: Address so �%a ti�L..ArI Contact Person: (Attach Proof of Ownership & Legal Description) .5 V7111 --7® StateLicense Number: eF 0,0 d d 1% d )AVtjt-' 016 oltC� Ph.., --46 7 -:51,0 %/ -1 -7 Phone: Fax: Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. 1 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 1 will notify the owner of the property of the require da Li w, FS 713. Signature of Owner/Agent Date Signatureof Contractor/Agent Date Print Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced ID APPLICATION APPROVED BY: Bldg: Zoning: (Initial & Date) Special Conditions: Signature of�ry Staie of'Florida'hAiI'MII� Date �` �iI�WISS10N#'0164280 6 x4 %4r, y} it v' lil8 i t!ha02 OC jj r10;, i0cl!LY 1r i�G2?9iEFBi Contractor/Agent is Personally Known to Me, r Produced 1D h/N, \�Q(7(7_ s ©~ S (initial & Date) Utilities: (Initial & Date) FD: (Initial &Pate) I , .�':rf d �� r, 'f. I I -.. I I 11 ( 7 Vii, :J ' i•: I l to , 1'f�11-1' Y Y .5 SI`lf I I - .•;. t'. , t ,. .'ir l�.. Y i t: t/ .,y4 5 , i j, r; s � I '� t P art �� 5id 4 N 7 P I S' T H BY H R QN E 0 E S 1, I� r 5` tt cd r ,, : " ,.. .......-,�' a. t il 7 : 5 cd .., I , m.O 1 , P 7 bcd ,, N ,� I 11. lommillm , 4 QE 1 2 X R PN QV Eh 7 (w 5cd t ,: , . Np t N C 7 5cd S — 0 K' �5n/ 8: f Fiff ,' ON 2 � 75cd . 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