HomeMy WebLinkAbout505 W 11 St (5)r •
i
Permit # : A l\
Job Address: Vv�
Description of Work: 1J
CITY OF SANFORD PERMIT APPLICATION
Historic District: P O
Date: I I�
[ �-
Permit Type: Building-4—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-- RepaiRestdenti or Commercial __
Occupancy Type: Residential X Commercial '— Industrial Total Square Footage:
Construction Type: _� # of Stories: _L� # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Name & Address:
ID
Phone & Fax: —IV `�111 L - intact Person:
Address: �� Ax2 "'Dl 1l e
(Attach Proof of Ownership & Legal Description)
State License Number:
Mortgage Lender: b ) 1 n
Address:
Architect/Engineer: Phone: `"•
Address:
Fax: j
Vkk
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: I ad ' equirements of this permit, there may be additional restrictionsplicabl to this property that may be found in the public records of
this county, n there itional permits required from other governmental entities su h w agement districts, state agencies, or federal agencies.
Acceptan f ve t tilptl ill t`pti t e o / of he property of the requi ents f Flori L en w, FS 713. �� . •:�o�,
#d\3 1 �=
S nature of Owniiftee ate Sig a e of contractor/AgeQ bate O+
nn`
Print Own r/A ent's m /t�- N�
Print Contrac a
M, _ rn
�' r�,r c +1�Ne��d� GRAVE • / t of _ C Cp,
to - natu of N ry- e Florida Date a' �' CDD
D �
��,d MY COMMISSION # DD 164280 �
EXPIRES: November 12, 2006
d�q,FGi'r Via' Bonded Thru Budget Notary Services
Owner/Agent is Personally Known to Me or
roduced [D�
APPLICATION APPROVED BY: Bldg:k \ 14 _Ronin
(Initial & Date)
Special Conditions:
n2 -2
o
• N
Contractor/Agent is _ Personally Known to Me or " w M"
(Initial & Date)
Produced ID
Utilities: FD:
(Initial & Date) (Initial & Date)
1s3
F -L
v v I I L I I.$ %-AU-41 I I Vi u I I t-
4'11 5'1
10, 25'
35'
N.
Mi
et
to
CV
C'41
v v I I L I I.$ %-AU-41 I I Vi u I I t-
4'11 5'1
10, 25'
35'