HomeMy WebLinkAbout2017 S Cedar Ave7ti / ' / CITY OF SAlif'QRD PRRM11 APPLICATION
Permit M :_
0 (^/_) _ Date:
Job Address:., OL/ - rC R;;v LDescriptionofofWork: C n M '_- _ 5'e ri!l_C`_ -____ -
O ---- - _ moo, alietnrie Dhtrlet_ Zooms: - 'due Of Work: S •--- ... - --
Permit Type: Building _____. ElectricalMecba ical ___ Plumbing,__ Fire Sprudtleri.Alatm
Electrical: New Service - # of AMPS - . Aiditirrri' Alteration C:136110.11e of Sevvice K_- Temporary Pole . _ --
Mechanical: Residentisl Norl•Resideittial M_.,_,.
Replamment _T New __• (Uucl layout & Energy Cale. Required)
Plumbing/ New Commerdal: q of Fircram # of Water &. Sewer Lines # of (has Lines
Ptumbing/Nevr Reddendal: # of Watew Closets Plumbing Repair - Residential or Commercial
occupancy Type: Residential. Commereia! anclustrial ._•-.- Total Sqwrt Footage: _
Coostruetion Type: # of Stories: _ M of Dwelling Units: flood Zone: _. (FEMA form required for other than X)
Panel N: _-- _ (Aaech Proof of Ow"w9bip & Legal Dttseriett"I
U+vners \ame & Addrtu: _ a_f,L=+=f 1r __ALL V.ZL
Contractor Na e @ Addre-1 — 1 ACT f^/ C ---- -_ _=--
P til t7 f _ --- I _-__ State 1.teense N`eretti t- _.._--__ --
1- G 3-3
Phone de Fax: _-:%`1?
T --
Z _ contact Person: J C k 5 LT t Pbooe: --. 7 2 a %
Bonding Company:
address:----
Murtgage Lender.
Architect/Engineer: am— ____.._- --•---
Phom:
Addrrsa: - _ ---- -
Fax:
A;pli.a ion a hereby made to obtain a permit to do the wc-4 and installauoos as 'indicatcd. i cord ~ that no work or ir'"iation has corrt:neneed pnoi to Ux
issuance of a permit and that sU work will be performed to meet standards of all laws regulating construction in this jurisdietien. I uudsratand that a separatepermitmustbesrcumdforELF,CTRICA.L WORK. PLUMBINts, SIGNS. WELLS, M,)LS, FURNACES, DOILERS, I#EATERR. TANKS, and
AIR CONDITIONERS. etc.
QW'NER'S .A jDAV1T: I certify that ak of the foregoing infotmatio:t is sccuratt a:td that all work will be done in compliance with all applicable laws tc9ulat:n.9constructionandconing. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CONI.MENCEMENT MAY RESULT IN YOUR PAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTYIFYOVINTEND10Qt3TAirFINANCING, CONSULT WITH Y(XM LENDER OR AN
A fTORNEY BEFORE RF_COROING YOUR NOTICE OF COMMENCEMENT
jrQTUQj : In addition to the wquirements of this permit, there may be additional rta5rictions applicable to this property that may be found in the public records od
thtc :oven•• and there may be additional permits required fruit other governmental enutiec Such as water m district,, state agencies, or federal agcncits
A::ceptance of permit is %erification that I will .-jotity the owner of the propert), of tht req' ' of
Signature of UwtleriA=Ent - - --- Date gnm re of ContractortAgent - Dee
Print (Tenet/Agent's Name
Signature of NotaryState OFF Ionia - Date
Owner/Agent is _-_- Persuna!!y Known to Me or
Produced ID — _...---•--.._-
Pr
tV1,:Z cBB!E ELANTONi3nsturrofo"rys of Fldrida:G. :O:J +;Aare+ 180a91
EXF;s _5: rcbrurry E5, 2:07
1= A".•F J t,t rL h ria-1 Diu-u^t A-30C.
Contractor,'Agent is __. Personally Knoom to Me or
Praouu:d ID
xYYLllATION .APPRGVELTBY.B Zoning: _ _••Utilities:__ Initial &
ate) (Initial dt Datei ((nitisl & Date) (Initial do Daze) special
Candtaons: