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Permit #:LA q-1 CITY OF SANFORD PERMIT APPLICATION
Job Address: / Sys 0
Description of Work: "t-el—
Historic District: Zoning.
Date:
Value of Work: $ Y f— c4 )
Permit Type: Building Electrical Mechanical PlumbingFire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary PoleMechanical: Residential Non -Residential Replacement New (Duct Layout & Energya'Q' Calc. Requited)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of water Closets Plumbing Repair' den ' 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:
Contractor Name & Address:
t*) r( lT
Attach Proof of Ownership & Legal
Phone:
t -State LicenseNumber.Number. /1)— 110/7// ? Phone &
Fax: L/d - f 2 _ Contact Person: /4/ Phone: _'707- Bonding
Company: Address•
Mortgage
Lender: Address:
ArchitectlEnglmete
Address:
Phone:
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 issuanceofapermitandthatallworkA
be
per to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate permitmustbe. secured for ELECTRICAL WORK, PLUMBING, SIGNS. WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIRCONDITIONERS, 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 TWICEFORIMPROVEMENTSTOYOURPROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFORERECORDINGYOURNOTICEOFCOMMENCEMENT. 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 thiscounty, 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 Signature
of Owner/Agent Date Print
Owner/Agent's Name Signature
of Notary -State of Florida Date Owner/
Agent is _ Personally Known to Me or Produced
ID APPLICATION
APPROVED BY: Bldg: - . Zonisg Inith
Date) Special
Conditions: FS
713. 03 )
Ctq PtWSION
f DD 16421Vate EXPIRES:
November 12, 2006 Bonded
Thru Budget Notary Services Co
for/Agent is Personallyy Known to Me or Produced
ID \ \n T s,- 1 E,_L, Initial &
Date) Utilities:
initial &
Date) FD:
Initial &
Date)