HomeMy WebLinkAbout1113 Fulton St (2)e
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CITY OF SANI.ORD PF.RM11 APPLICATION
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Permit # _— Y ^ I I22 __ Date:,
1--.-.--
Job
Description of Work: _- .2. i.. ._.Q _ -_l} %3 tz
Historic Distrkt: 7soiaig: Value of Work: S. .... —
Permit Type; Building Electrical _L_ Mechanical __. Plumbir-9 .w_- Fire SprinkiffiAlum _ __ Pull
Electrical: New Service - # of AMPS -_ AJcii1i0IvA;tera0on -- Changes of Service --__ Temporary Pole
Ntechanica{l: Residential Non -Residential _._ Replacement ____- New pict i•eyout & Energy Cslc. Required)
Plumbing/ New Commercial: # of Fixtures ,_ . # of Water It. SOwYr l,incs # of f3us Linos
PlumbingrTew RnMential: # of Wster C30SCIS Plumbing Repair •- Residential or Commercial
Occupat$cy Type: Residential C trummial - Industrial ___ -..- Total Square Footage: _ —
Construction Type: # of Stories: of Dwelling (mitt: Flood Zone: (FEMA form required for other than X)
Parcel 0: ^ oC -- Cj - 3 0 -SQL _ d b 00 0 0 O IAttach Proof of OwaenNp & Legal Aesr ript{oo)
Owners Name & Address:
none.
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Contractor Name &Address: C PC / YI G 7--Nr, G VI/ ••-
sAl l O
Oq7-)L $tate I:lease Nember..Sr.
Phone & FerPhotaa:- _.3 a
Bonding Company:
Addretr _. ,
Mortgage fender.
Address: ._.._
Archlrect/Engineer:
Address:
PboaE:
VON
A ppiicatron a hereby made to obtain a permit to do We wort and installations its indicated, { vertr7L :het no work or installation has commenced prior w the
j) Issuance of a permit and thrt sit work wil! be performed to meet standards of all law$ regulating wnstrucdon in this jurisdiction. 1 understand that a aaparatepermitmvstbesecuredforELECTRICALWORK. PLUMBING. SIGNS. w'P.L[.S, POOLS, FURNACES, BOILERS, HEATERS. TANKS. and
AIR CONDITIONP.RS. etc.
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f Qt6 JAEB12AVJ i c:ortihy that all of ite foregoing information is eccurete and tha! all work will ne done in compliance with all applicable laws reRu{atmgconstructaanandzoning, WARNING TO OWNER: YOUR FAILURE TO RECO. RD A NOTICE OF CO!AMENC[EMENT MAY RESULT IN YOUR PAYINGFW10EFORISIPROVEMENTSTOYOURPROPERTYIFYOU ;NTEND TO OBTA:v' FINANCING, CONSUL. WITH YOUR LENDER OR AN
ATTORNEY BEFORE RF_CORDING YOUR NOTICE CAF COMMENC•F.MFNT
F,S _TICr%: In additim, to the requirements of this petmrt, trier+. may be additional rt.striCtionS appiicat.le w thin ny that may be fowid in the public records of
m enure, and theft may be additional permits required feriZl other governmental entitiei Such cc-+r' districts. state agencies, or federal agencros.
Accervince of permit is verification thal 1 will iotify the owner of the oruperr-, of the regd t 3 _2
Signature of UwnerrAYent _~ _ Darc Signature of 0wrsctor/Agent Date
Print bwner!Agent's Name
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5ignaturr of Notary -State of F {onda Date.
OwnertAgem is ___ Personally Known to Me or
Produced ID
Pri — ntea V ; nt's N•
P T`oie t atei;ne;vrr of u 5uttttggqqof Fleni!a
MAY COS:...:--S!ON # DD 186491
E."WiRES: February CS, 2-07
t•_J9•C•` O-AH'r Z ttMts/ DicrI•-IAmcc. C,4. oorack+
dA jentis =`_ PcrsonsllyKnown•to-Me.or AF•
PLiCATION .ANPROVEL` BY: H — (A)IUrIQ: _____ .. Utilities: _ _ FD _ Initial &
Ua101 (Initial & Datel (initial & Date) (Initial &Dates