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HomeMy WebLinkAbout109 Hazele Blvd (2)CITY OF SANFORD PERMIT APPLICATION Permit # : C> (p - CIOJ— Date: Job Address: NAAZ' CLc 7 (rV S 1 F.ot2 I=-=_ Description of Work: Ovcrt_ '$ 3 F fltVs 1 19 W i-rC.{tp r. r L l Historic District: Zoning: Value of Work: $_T fl Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service — # of AMPS Mechanical: Reside i3f—Z o Non -Residential Plumbing/ New Commercial: # of Fixtures Plumbing/New Residential: # of Water Closets _ Occupancy Type: Residential Commercial Addition/Alteratio Change of Service Temporary 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 than X) Parcel #: Owners Name & Address: Contractor Name & Address: iN P0% 1 Attach Proof of Ownership & Legal Description) Phone: State License Number: 75-- tZ \ S Phone & Fax: `'' w 425 N Contact Person: CN N V F Z- Phone: Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Phone: Address: Fax: 4 13Z 407 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. 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: 1 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 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 lorida Li FS 713. Signature of OwneriAgent Date Signature of Contractor/Agent Datc ` J V e -n -,7 k'o tz't Print Owner/Agent's Name Print ontract g s Name y Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date Owner/Agent is _ Produced ID Personally Known to Me or APPLICATION APPROVED BY: Bldg: Initial & Date) Special Conditions: Zoning: FLORENCE A DE DRAW MYCOMMISSION lIDD 1642P C t cn1Q i(jES$ wn to Me or P . ID t*+a+ 1- 1 S - a Initial & Date) Utilities: FD: Initial & Date) (Initial & Date)