HomeMy WebLinkAbout204 Meadow BlvdCITY OF SANFORD PERMIT APPLICATION
Permit # : Date: -J-
Job Address: V,.)
Description of Work: CdfyJ6E o07 3- &,.,L? a
Historic
District: Zoning: Value of Work: $ 3 ;] 1 R 0 Permit
Type: Building Electrical Mechanical i Plumbing Fire Sprinkler/Alarm Pool Electrical:
New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole Mechanical:
Residential Non -Residential Replacement _)gL 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 Construction
Type: Parcel #:
Owners
Name & Address: _ PL,
Contractor
Name & Address: D64
ti%4 Phone &
Far. Bonding
Company: Address:
Mortgage
Leader: Address:
Architect/
Eagineer: Address:
of
Stories: # of Dwelling Units: Total
Square Footage: Flood
Zone: (FEMA form required for other than X) Attach
Proof of Ownership & Legal Description) Phone:
State
License Number: GtL y Svy bZ Contact
Person: kyI.J Phone: C.yi.) "S 8?SL Phone:
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: 1 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 require 7of
Florida
Lien Law, FS 1 13. Z'1
7 •0G Signature of
Owner/Agent Date Si of Contia tor/ genr 1 W Date Print Owner/
Agent's Name Pri Contractor/Ag N1ne Signature of
Notary -State of Florida Date Si ture of Noiary!)F4 Flo ate Marcie Roonpuss
s My
Commission DD327559 p rdr
Expires June 09, 2008 Owner/Agent
is _ Personally Known to Me or Contractor/Agent is Personally Known to Me or Produced ID _
Produced ID APPLICATION APPROVED
BY: Bldg. O Zoning: Utilities: Initial & Date) (
Initial & Date) Special Conditions:
153 FD:
Initial &
Date) (
Initial & Date)