HomeMy WebLinkAbout111 E Lake Mary Blvd (5)Permit #
Job Address: !
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION /
j0Date:i " CJ
N1y.-e S/ X/v/0
C 7—A" C 11
Zoning: Value of Work: Uvcv
Permit Type: Building Electrical
i'—
Mccltanical Plumbing Fin: Sprinkler/Alarm Pool L
Electrical: New Service — # of AMPS Z 0 O Addition/Altenition Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Ca1c. Requires
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercia} _
Occupancy Type: Residential Commercial A--rndustrial 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:
bone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Arcbitect/Engineer:
Attach Proof of Ownership & Legal Description)
Phone:
ecr.Kic
State License Number: L c CJ Oy Contact
Person: "*W I AI! Sur / r.0 Phone: 4 Phone:
Address:
Fax:
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 issuanceofapermitandthatallworkwillbeperformedtomeetstandardsofalllawsregulatingconstructioninthisjurisdiction. 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 constructionandzoning. 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 1 will notify the owner of the property of the requirements of Florida ie , FS 71 . Signature
of Owner/Agent Date Signature of Contractor/Agent Date Print
Owner/Agent's Name Signature
of Notary -State of Florida Owner/
Agent is _ Personally Known to Me or Produced
ID APPLICATION
APPROVED BY: Bldg: Initial &
Date) Special
Conditions: la-
Ib•3 Date
t Date My
COMMISS p 164281) EXPIRES:
Nov0011 , 006 ov°
Bondsd ThN BuOpst Navy tractoi//
lgent is Personally Q-vm to Me or Produced
ID S7 3 G' J i- SA-P- 4kZQ - 4 Zoning:
Utilities: FD: Initial &
Date) (Initial & Date) (Initial & Date)