HomeMy WebLinkAbout106 Blue Spencer CtCITY OF SANFORD PERMIT APPLICATION
Permit # : 0 - Date: LeI I OLD
Job Address: Int C,
Description of Work: Total Square Footage
Historic District: Zoning: Value of Work: $
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 Replacement New (Duct Layout & Energy Calc. 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
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
Phone: 'to-7 - i 6 0- lx'l o' j
Contractor Name & Address: 1-A • C.L.x
iC)q lState License Number: F_c Oo0 %La to 3 Phone &
Fax: Contact Person: Phone: 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. I certify that no work or installation has commenced prior to the o 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 R c permit
must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and o Q AIR
CONDITIONERS, etc. y •
o c 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 0
Z
construction
and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING n 9 TWICE
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN .g
ui .
2 ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. m
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. Zo E U m
Acceptance
of permit is verification that 1 will notify the owner of the property of the APrintactor/
Agent's da
Lien L S 7 % ,,...r.,,, 2
V
C/ Q° As Signature
of Owner/Agent Date Si c Date y 8; Print
Owner/Agent's Name m Signature
of Notary -State of Florida Date Signatur4 of Notary -State of Florida Date Owner/
Agent is _ Personally Known to Me or Produced
ID Contractor/
Agent is _'Personally Known to Me or Produced
ID APPROVALS:
ZONING: UTIL: FD: ENG: BLDG: Special
Conditions: Rev
03/2006