HomeMy WebLinkAbout110 1 Sti RECEIVED
CITY OF SANFORD PERMIT APPLICATION
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Permit N : t(c""' I -1 '7 „/ Date:
15 oOpC
Job Address: I 169 19r ^ 5-r- W . '5tJ Q =-V PE-9=> 37- 7 -1
Description of Work: ( 60 s V 1 &4 t>O W 6 1?-, Af=-H 1 G S
Historic District: Zoning: Value of Work: S O U • Q J
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - N of AMPS Addition/Alteration Change of Service Temporary Pole _
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: N of Fixtures N of Water & Sewer Lines N of Gas Lines
Plumbing/New Residential: N of Water Closets _ Plumbing Repair - Residential or Commercial _
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: N of Stories: N of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel N: F l 0 5A GI • 07-0
w•
00 -30 (Attach Proof of Ownership & Legal Description)
Owners Name & Address: l Z O 6. (pO A j //AL, I>Q
O<L.AlJCPC;P Phone: AP-7 00-09
Contractor Name & Address: -J h 7q L U Z S 3t W . i J/KAQ J= .
AF7oy-&A *L/
1'
Fz? j,' State License Number: 0 e- 7115 Od0 001A
Pbone & Fax: 4O'1 000 7 7 07 Contact Person: J)f AA FL->E Phone: - 101
Bonding Company:
Address:
Mortgage Leader: ti/4
Address:
Architect/Engineer. %t 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 petionntd to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate
permit must be secured fDr 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 FAR 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 management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
Signature of OwnerdAgent Date ture of Contractor/Age Late
1 A _ . -- 11 r%, r-- - ...
Print OwnertAgent's Name
Signature of Notary•State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
I Name
of Notary -State of Flori DateSUSANA NAVAK0- W COMMISSION 4 DD 26W10
D EXPIRES: November 19, 2007
Contractor/Agent is _ Personally Known to me or
AeProduced ID FL 17 L.
APPLICATION APPROVED BY: Bldg: 0 Zoning: l/ 41W Utilities:
Initial & Date) (Initial & Date
Special Conditions:
FD:
Initial & Date) (Initial & Date)
CITY OF SANFORD HISTORIC PRESERVATION BOARD
APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
P.O. Box 1788, Sanford, FL 32772-1788
Phone: 407 330-5672 Fax: 407 330-5679
TO: FE HISTORIC PRESERVATION BOARD OF THE CITY OF SANFORD, FLORIDA
tl Downtown Commercial Historic District D Residential Historic District
D This application is filed in response to a notice from the Code Enforcement Department
ADDRESS OF PROPERTY: / 0 / > j ?"- /AJ-_ 5;-4)Fam 30 —7
Property Owner
Signature: HGiGYaL.AilJD OIL-) I+-,IG, Print Name:
MailingAddress: j LO CCIG.U J I G.. L1rz-• ogre • 37—qW1 Phone: -
ly ( 8 i 2 Q Zp Fax: ARplicant/
Ag t Signature:
PAM- Print Name: Mailing
Mess:V,6 »z=> ArrS/p#
A -
a Phone: 7 /
Z.
Fax: - - I
certify
that all informatio co twined m this a plication is true and accurate to the best of my knowledge. Applicant/Owner:
Date: Z' /S Please use
the attach teria check]' t guide to completing the application. Incomplete applications cannot be reviewed and
will ed to you for more information. You are encouraged to contact the preservation planner at 407-330-
5672 to a sure your application is complete. Description of
Proposed Work/Application Category: (Check all that apply) o Site
Improvements/driveway/walkway oSto a
shed
o Moving structures o Replacement
windows or doors skirting o Awnings o New
construction/additions o Demolition o Roofs/
gutters/downspouts o AC/Mechanical o Fences/Gates/Pergolas o Replacement
siding/flooring/porch o Paint o Other Completely describe
the entire scope of work: all changes in material, color or location to the exterior of the building, where on
the property the work will occur and how the work will be/ac complished. For large projects, an itemized list is m recomended.
Attachadditional pages if necessary. ` 4 r!-
A Certificate
of Appropriateness is valid for six months unless otherwise noted OFFICIAL USE
ONLY Historic Preservation
Board Meeting Date: Staff Review Date: Application is
Approved V/ Approved with Conditions Conditions: Signed:
Date:
Denied This
Certificate
must be prominently displayed on the building when work is in progress*** FASHA_EWHistoric
Nesmation Board\C of A Application.doc
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