HomeMy WebLinkAbout107 Wilkins AveCITY OF SANFORD PERMIT APPLICATION
Permit # : 04— 3 4" / Date:
Job Address: I O%
Description of Work:TZGs-
Historic District: Zoning: Value of Work: $ dll(3
Permit Type: Building Electrical Mechanical Plumbing Fir, Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS L.O L Addition/Alteration r/ Change of & vice 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 Tyne: # s'_' Stc e;; ri of DwellingUnits: Flood Zone: FEMA form required for other than X)
Parcel #: (
Attach Proof of Ownership & Legal Description)
Owners Name & Address:
7
Phone:
Contractor Name & Address: KO/$E/ZirG E C'y iC _L-t/
J 3r•' t<r iV Ci F1en/ILI VU IBC t55j4 3 y75/V State License Number: 0 00 02 7 0 Phone &
Fax: '1/ % $if7 SO a10 Contact Person: /TL /Cn, nzwc &' Phone: V0 7'- .9417 ^ q 1(,, 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 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
countvc Pnd thenz many be add".;,nal pe in t;, required fiom other governmental entities such as water management districts, state agencies, or federal agencies. Acceptat
of the requirementsA Fl n a Lien La 713. 47
Si
ature of Contractor/Agent Date% Print
Contractor/Agent's Name iyt
D--2 G rr /! Q Signature
of Notary -State of Florida Date TENNESSEE
ANN SANDERS 1 ,
A MY COMMISSION # CC 961378 Owner/Agent is Personally wA` , or ctor/A ent is Per n on to SCOTTWARNERgogRES: Aug I5, 2004 Produced [D _ *_ . MY
COMMISSION # DD 16809 Produced I D t.Si M1Z_ti Tso , s
h $ pontng, ItI¢ Vie=
EXPIRES: November 28, 2008 ,,. e "
Bonded ThN Nota APPLICATIONAPPROVEDBY: Bld R,,,h``P ryPu6lbUrWenvrNers g
Utilities: FD: Initial &
Date) (Initial & Date) (Initial & Date (Initial &Date) Special
Conditions: