HomeMy WebLinkAbout107 Ellen Pl (2)CITY OF SANFORD PERMIT APPLICATION
Permit # . Date:
Job Address: / 0 ;Pt' F l-L C N P t-A GE
Description of Work: C//fiyG 5 Our
Historic District: eA - Zoning: Value of Work:
0—
Permit Type: Building Electrical _M( _echanical ] Plumbing Fire Sprinkler/Alarm Pool
N/A Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanica Residential Non -Residential Replacement New (Duct Layout & Energy Cale.•Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
o 1Q Plumbing/New Resid ' 1: # of Water Closets Plumbing Repair - Residential of Commercial
Occupancy Typ Residential Commercial Industrial Total Square Footage:
Construction Type: # of Storks: I # of Dwelling Units: Flood Zone. (FEMA form requlrad fnr other than X)
Parcel #: 3 / -/ - ! /- S 2 / + U 6, DU O e g (Anacb Proof of Owoersbip & Legal Description)
Owners Name & Address: -L'AR [. O Cs/N /f V.0 Te=/i 0 W j7 wA L 7-0 A.,'
Phone: U - 3 2 d' - S/9
Contractor Name & Address: W e SON A/R //I. -- . / b /fig y W& d *Cle L U/t/G wcpaa _j a Z nS0
State License Number. C ,,o9C— 0,1` 6 .;d,6
Phone & Fax: "IYO,Y Zs'** OContaet Person: x0er Phone- S/U.- 973/ —1 -p6 /
Bonding Company: AV4l _
Address:
Mortgage Lender: 61-Yi4
Address: &a
Arcbitect/Engineer: ,(L/¢ Pboue:
Address: A1IA 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 qII 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" all work will be done in compliance with all applicable Nwr moulating
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 managem districts, state agencies, or federal agencies.
Acceptance of permit is verification that 1 will notify the owner of the property of the requirements of F irn Law, FS
Z!; ae-b
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name Print Contractor/Agent's Name
1
Signature of Notary -State of Florida Date pature of otary-State of Florida Date D L H SCHNEIDER
Noisy PuNic, State of Florida
My comm. up. Sept. 17, 2W6
Owner/Agent is _ Personally Known to Me or Contractor/Agent is Personally Known to Me or COMM. No. DD 150411
Produced ID _ Produced ID
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions:
Zoning:
Initial & Date)
Utilities: FD:
Initial & Date) • (Initial & Date)