HomeMy WebLinkAbout1018 WP Ball BlvdPermit # : 0 — G
Job Address:
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date: 1 l o D b
A1_. d
Zoning: Value of Work: S F
Permit Type. Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential 4- 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 tl -300 - oo30-O`2
Attach Proof of Ownershin & Le021 Denn rrinfilOwners
Name & Address: X
0
Phone:
I v Contractor
Name & Address: &L ", i- I, 4 L(A (y i C 15 6& , ) 3 (1 S i, t /•Lp u C0353OStateLicenseNumber: Phone &
Fax: O b Flo oZ 6Ooo ontact Person: Phone: 0Z, Bonding
Company:-' Address:
Mortgage
Lender: Address:
Architect/
Engineer: Phone:
Address:
Fax:
Application
is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the issuanceofapermitandthatallworkwillbeperformedtomeetstandardsofalllawsregulatingconstructioninthisjurisdiction. 1 understand that a separate permitmustbesecuredforELECTRICALWORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIRCONDITIONERS, etc. MIA
91,
J , / OWNER'
S AFFIDAVIT: 1 certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructionandzoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT rN YOUR PAYING TWICEFORIMPROVEMENTSTOYOURPROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFORERECORDINGYOURNOTICEOFCOMMENCEMENT. 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 thiscounty, 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 Florida n Law, 5 713. ,.,/ Signature
of Owner/Agent Date Signature of ontractor/Agent Date Print
Owner/Agent's Name Print
Contractor/Agent's Name Signature
of Notary -State of Florida Date Srgnalure of Notary -State of Florida 15ati iaml—
MARSHA HORAL Owner/Agent is _Personally Known to Me or it NoieProduced IDAPPLICATION
APPROVED BY: Bldg: Initial &
Date) Special
Conditions: r4`
oBonded By National Nol ry Assn. Zoning:
Initial &
Date Initial &Date) (initial &Dale)