HomeMy WebLinkAbout125 Mayfair Cir (4)CITY OF SANFORD PERMIT APPLICATION
Permit #: (D V - / / Date: cP- ^ — Q-o o 6
Job Address: i a S M P y r'"I" I R G( C I Z
Description of Work: K L—
Historic District: Zoning: Value of Work: $ W a 3 c,0o 0
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
I
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential 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:
Attach Proof of Ownership & Legal Description)
Phone. -To/ .SL. l l (1-5 ( C911
Contractor Name & Address: ..S E Z_
State License Number:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Contact Person:
Architect/Engineer: 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 commencLd 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, cic.
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 TICE: In addition to the requirements of this permit, there may be additional restrictions applicable to ibis property that may be found in the public records of
Ibis 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 Lien Law, FS 713.
C;) hecc6Si
ature of Owner/Agent Dale Signature of Contractor/Agent ES
Ge R P '
wncr/A cnt's Name Print Contractor/Agent's Name t`.
Signs
a of.Nuta j;Stateof Date Signature of Notary -State of Florida DEBBIE
BLANTON GC '
d:; S:ON # DD 18MI r•
r r• Date
Dale
Own
Agent°is _ •Personally KWiWt6 Mebr Contractor/Agent is _ Personally Known to Me or P
duc24V16-7 'v !• 14rnery Zvc . •rxI`u Produced ID APPLICATION
APPROVED BY: Dwe)
Zoning:
Utilities: FD: (Initial &
Date) (Initial & Date) (Initial & Dale) Special
Conditions: ,,`` v