HomeMy WebLinkAbout200 E Lake Mary BlvdPermit # : 6 , 3 3
Job Address: -2 it all
Description of Work: I V1 J r4111 SC
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
Date:
0, GJ M Ff., rtcl f ~)- r
Value of Work:
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Altemtion Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. 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 #: (
ttach Proof of Ownership & Legal Description)
Owners Name & Address: d'
Phone:
Contractor Name & Address: N, V n y1•..iy WN. C 1
Phone & Fax:
Bonding Company.
Address:
Mortgage Lender:
Address:
State License Number: XFr— S-7 Q t S
Contact Person: Phone:
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 commenced prior to theissuanceofapermitandthatallworkwillbeperformedtomeetstandardsofalllawsregulatingconstructioninthisjurisdiction. 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
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 ofthiscounty, 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 1 i ie
Signature of Owner/Agent Date 1110tu o Contractor/Agent Date
L- SignatureUN,WPrintOwner/Agent's Name gent's Name
y U
of Notary -State of Florida Date ry-State of FloridaDate
FLORENCE A DE GRAVF.
MY COMMISSION it DD 16426
Owner/Agent is _ Personally Known to Me or Co t EXPIR NovempQr
o Me or
Produced ID P$b iced ID
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions:
Zoning:
Initial & Date)
Utilities: 4s3
Initial & Date) (Initial & Date)