HomeMy WebLinkAbout203 Marc St (2)p`;r a\+'t,
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CITY OF SANFORD PERMIT APPLICATION
Permit # : fr Date: (JI 1 D LJ
Job Address: aQ3 ry c,!Lc -z -
Description of Work: h; v P-Q Fovi-
n
Historic District: Zoning: Value of Work: $ io
Permit Type: Building a _ Electrical
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
Parcel #: I O - o(U - S
Owners Name & Address:
Mechanical Plumbing Fire Sprinkler/Alarm Pool
Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. Required)
of Water & Sewer Lines # of Gas Lines
Plumbing Repair - Residential or Commercial
Industrial Total Square Footage:
of Dwelling Units: Flood Zone: (FEMA form required for other than X)
5VI - 0000 - 057a0 Attach Proof of Ownership & Legal Description)
oltJ MaRc • S 1 _ ScinftrA,-(:t 327 73 Phone:
Contractor Name & Address: tn1 :3'P W i J o,a,5
0S SaJaa2 Cj,-. Lon „ano I fZ a27.1 o State License Number: CC( 057&a6
Phone &Fax: SLk7 >I ) 65 'a a,lS Contact Person: ma OZ4-; . Phon,(4V 2J a 6 5 - -771 S-
Bonding Company: / N
Address:
Mortgage Leader: N I A
Address:
Architect/Engineer; N / A Phone:
Address: Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced 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, 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 of
this 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 FS 713.
1 ' 'tt' Z t I, /D )
Signature of Owner/Agent Date Sign aat ure of Contractor/AgentDate yy
1' Ic.it `Th 1 r/
2`
r1 ^ II qDr Print
Owner/Agent's Name Pyirlt Contractor/Agent'sAName , Signature
of Notary -State of Florida Owner/
Agent is _ Personally Known to Me or Produced
ID APPLICATION
APPROVED BY: Bldg: Initial &
Date) Special
Conditions: Date
v Signa re ooJ-
NOi Con
Produced
ID MY
COMMISSION # OD 1 OW1 EXPIRES:
February 25, 2007 oby
Zoning:
Utilities: FD: Initial &
Date) (Initial & Date) (Initial & Date) 0