HomeMy WebLinkAbout2921 Orlando Dr (17)„. CITY OF'SANFORJ PERMIT APPLICATION
Permit # : J r- Date:
Job Address:
Description of Work: r11 I^ Al -A f P, 1L= o K
Historic District: NU "Zoning: [rG - -� Value of Work: $ 7_0-_
Permit Type: Building _ Electrical
Electrical: New Set -vice — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy'I'ype: Residential Commercial
Mechanical Plumbing Fire Sprinkler/Alarm Pool
Add itiorn/Alteration Change of Service Temporary Pole
_ Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lincs # of Gas Lines
Plutubing Repair—Residential or Commercial
Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone; (FEMA form required for other than X)
Parcel It
Name & Address:
U , Ro,
Contractor Name & Address:
Phone &'ax' %G°'/`' _//”'
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Euglneer:
Address:
(Attach Proof
of Ownership & Legal Description)
hone:
s•L;LLState License Number: / p
Contact Person: V, / j W, G' Phone:
Phone:
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 addition- I permits r tuired from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit is veritica on th I will it tify the owner of the property of the requir +irets(s of Florida Lien
�.a FS_�l3.
Signature of Owner/Agen Date Signature of ontractor/Agent Date
Yr' t Owner/Agent' N in l' inCantmctor/Agent's.t'n/c2 �l 03�--
5tgriYt re of Notary -State of Florida Date Signa6TofNotaryStfatteeofFOQ*GRAVE Date
pt/o, , Fi_ORENCE A. OE GRAVE KY PUB E A. #
COMMISSION # DD 164280 4 MY COMMISSION # DD 164280
�t .,X �4Y 0 o-
�� c 1 EXPIRES; Novambel 12,
itX $'�ryho�� to Me or Ca�tra��ig dvtidedllaudi>r11�n°io Me or
lJtpdtced(f''SruQu tna �� ( 1'ro�r�u"CtlIDC�
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APPLICATION APPROVED BY: Bldg:1/ M f `3 Q^`' l "Coning: GP Utilities:
(Initial & Date) (Initial & Date)
Special Conditions:
FD:
(Initial & Date) (Initial & Date)
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