HomeMy WebLinkAbout209 W 25 StY M
CI`T'Y OF SANFORD PEU MIT APPLICATION
0312A.61
7
Permit No.: _ l/ Date:
Job Address:D
Permit Type: L" Building Electrical Mechanical Plumbing -Fire Alarm/Sprinkler
Description of Work: P�Y�')tT1/z� d �LE�L1�� <<o <Q') 1i YJ.�. ��
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Additional Information for Electrical & Plumbing Permits
Electrical: Addition/Alteration Change of Service _.Temporary Pole -- New AMP Service (1/ of AMPS
Plumbing/Residential: Addition/Alteration New Construction (One Closet Plus Additional)
Plumbing/Commercial: Number of Fixtures Number of Water & Sewer Drainage Lines_ Number of Gas Trines
Occupancy Type: Residential /Commercial — Industrial 'Total Sq Ftg: Value of Work: $ 396 ?' (90
_
Type of Construction: / Flood Zone: Number of Stories: w Number of Dwelling Units:
Parcel No.: ��e�%���� ,�Lf 0/00 - ®UO (Attach Proof of Ownership & Legal Description)
Owner/Address/Phone:07,81, 13,fwer- d, L��/S//7�1'=�`�ivn v
Contractor/Address/Phone: A?6_% �v G` l/�C • ;�'//'l -
rinlvrG6 42 7 23 YV A -Ra-- 6111- e State License Nurnbe/r/
Contact Person: R i L'!pp C O `00)q/v�j oe�d Phone & Fax Number:
Title Holder (If other than Owner):
Address: A A�
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer 1..Cl'Y'i'i
Address: p0•_
.SCS__/�
Phone No.: '386 74 7
Fax No.:
Application is hereby made to obtain a permit to do the work and installations as hidicated. I certify that no work or installation has
commenced prior to the issuance of a permit'and that all work will be performed to tneet standards of all laws regulating construction
in this jurisdiction. t understand that a separate pennit must be secured ibr 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 '1'O RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WTTH 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 requirements of Florida Lien Law, FS 713.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Prhit Ow
ner/A
gent's Name 7
Signature of Notary-State-goflPl cla... u� f ....r..=
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DID0174321
Exp' _ ; ..i 13/2007
t'Ra Bonded through =
::.(800-432-4254) Flod 'a Notary Assn., Inc.
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Owner/Agent is Personally Known to Me or
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APPLICATION APPROVED BY:
Special Conditions:
KI'J)a A Z
Print Contractor/Agent's N
Signature of Nota State of 'I --- MAR�af6PARK4R..
' Commisslon # DD0174311
t xplres 1!2/2007
11"IN"�.,,,,;;,���` Bondod through
(800 4324254 �Florl&; Notary Assn.. Inc.
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Contractor/Agent is V"Personally Known to Me or
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