HomeMy WebLinkAbout110-120 W Lake Mary Blvdvy lc•s-'^+ +•//•'4+[-"r y'Y-'r-;ti 1K;,'r+-!r'-••--
CITY OF SANFORD PERMIT APPLICATION
Permit # : OV ` S7.r
Job Address:
1 /10-IZC w' Flo /
Description of Work: ( _
Historic District:
Date:
Y to^r /tPw %C/tam^ .
Zoning: Value of Work: S 20S'O • va
t
Permit Type: Building Electrical _.X— Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Addition/Alteration ie Change of Service Tempot'ary Pole
Replacement New (Duct Layout & Energy Calc. Required)
of Water & Sewer Lines # of Gas Lines
Plumbing Repair— Residential or Commercial
Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other thau X)
Parcel M
Owners Name & Address:
Attach Proof of Ownership & Legal Description)
W PV• LOLXe An.X^".7V7-CT Phone:
Contractor Name & Address: Z44 d 61ec 7 e., c- LSL2 S5 a / G ti9t77"a % 0 !
L4t c/T ic
SSttate
License Number: EIS 3r/ _ Phone &
Fax: 3 ZZ l G 2 IC 3 3f1 "l %G Contact Person: 'J/ !• !Gs P.."1 Phone: 0 0 7— P!%•v z/ % Bonding
Companly: el4l& Address:
Mortgage
Lender: Address:
Architect/
Engineer: / Phone: Address:
Fax: I
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 issuance
of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. 1 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. N
T10E: 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 o 'da Lien La FS 713. Signature
of Owner/Agent Date a ure ontractor/ ent Date Print
Owner/Agent's Name Signature
of Notary -State of Florida Ommer/
Agent is _ Personally Known to Me or Produced
ID APPLICATION
APPROVED BY: Bldg: Initial &
Date) Print
Contractor/Agent's Na e i
Date
@ature of Notary -State of Florida Date of
r BARBARA HURLER Contractor/
Agent is Personally %m Exp. 1/1I05 Produced
ID or ar Y No.
CC 99d570 I *
WX" I10 wID. Zoning:
Utilities: Initial &
Date) (Initial & Date) (Initial & Date Special
Conditions: .