HomeMy WebLinkAbout2921 Orlando Dr (20)S
CITY OF SANFORU I'GRb11"1' Al'1'LiCA"1•ION
Permit #t I `-� - s Date: _
Jot) Address: Zlaj 0rJ, ,, ,-X) )fir Sv_
Description of Work: Cc Y117 V5 iae
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(listoric District: Doing: Value of Work: $ 1VD0
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alartrt Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole _
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cale. 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 it:`�' 36�
Owners Name & Address: -5AI4 , tj- - i
Contractor Name & Address: — 4,:-
4_ii.r"�
Phone & Fax:!""
Bonding Company:
Address:
Mortgage Lender: IAjji �g146
Address:
— O G /" (Attach Proof of Ownership & Legal Description)
Phone:
—J-), -.:.S�C/ xG Pi
License
1 i { 1
_ Contact Person: S ')<e ---
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Architect/Engincer; I'hon a.�. o. r r f t
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Address: SFax: i� ir®I kw
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify thacnrt work or instal a on s d`n"t c cedri5 d to the
issuance of a permit and that all work will be performed to meet standards of all laws regulating construetionin this jurisdiction. I understand that a separate +?:t
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 [MPROVEMENTS 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 pert, it, there may be additional restrictions applicable to this property that pray be found in the public records of
this county, and there may be additional p nits req. red from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit is veriftcat n that I it motif the owner of the property of the require r tts of Florida Lienf Law; FS 7 H.
'_. � J ..� -,—_•`--r t':; rya , . .
a Signature of )caner/Agent Date
ignrmre of ontractor! gent^_- Date
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Print OllCrlAgent�sName
• .� ,. . _ i ': Pt'int ntractorTAgel nt's i�7 -ft
,'11t11t`` C $
i o Cps Signature of Notary -State of Florida Date i a ore of Notary -S ate of Florida Dail
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tp1 ry ti
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aOwner/Agent is Personally Known to Me or Contractor/Agent is i'ersonu�llY Known to Me
2 o t�GCt ^ Produced ID D� Produced ID ��2'l `a�7� ti j /
Q P'� ATION APPROVED BY: B1d�i�tY1F d U Loring. Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
SIE` O`� � C4T'�LCY\tntc.� F,�� } �(,tCSUt Rv.•F- SC"^��-�:SL K
(initial & Date)
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