HomeMy WebLinkAbout2201 W 1 St (2)!f
CITY OF SANFORD PERMIT APPLICATION
Pe,i�2i�
Job Ad'ress:
Date: _ o-1 105 to 3
Permit Type:
Building _ Electrical
Mechanical
Plumbing Fire
Description of Work:
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3:-75 KP 111,1'ET C:1-1E:-:,I1i11CAX-
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1645 Et�A, -
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Additional Infformation for Electrical & Plumbing Permits
Electrical: —Addition/Alteration _Change of Service —Temporary Pole New AMP Service (# of AMPS )
Plumbing/Residential: Addition/Alteration New Construction (One Closet Plus Additional)
Plum bing/Commercia1: Number of Fixtures Number of Water & Sewer Drainage Lines Number of Gas Lines
Occupancy Type: _Residential _Commercial _ Industrial Total Sq Ftg: Value of Work:
Type of Construction: Flood Zone: Number of Stories: Number of Dwelling Units:
Parcel No.: ZCe - i4 30- 3M- 0041A - , (Attach Proof of Ownership & Legal Description)
Owner/Address/Phone: ►C,.rt.IT_F�SS
t -GCSE. til � 1+C I�.Z g�C'j"1'rL
Contractor/Address/Phone: �-J QECO E /1_ 2:101
32"1"1 State License Number: s��C70C�19QL�.
Contact Person: QL.LE1.1 F12E-( Phone & Fax Number:.L4m )324- 0201 -A*D )3? -0214
Title Holder (If other than Owner):
Address:
Bondi4ig
Address:
Mortg�?ae
Address:
Architect
Address:
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 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 r uire
Signature of Owner/Agent Date Signature of C n aci
(Z,)414M acs-
Print Owner/Agent's Name
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Signature $, t(s� • ida Date
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i9•';�a Bonded%O ';•OQPublic�
Owner/Agerfy.19/p$'�s`i�y Known to Me or
_ Produced W111hillpO
ents of Florida Lien Law, FS 713.
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/Agent
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Print Contractor/Agent's Name
ature
Contractor/
Produ
APPL1CAT10T� APPROVED BY,
Special,Conditions:
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y, #DD 168169 ; o
Date
a Date
•�:�td'ally Known to Me or
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Date:_
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OFFICHUry
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