HomeMy WebLinkAbout208 W 19 St (2)r -
CITY OF SANFORD PERMIT APPLICATION
Permit #:
7,,
W Date.
Job Address: ()J, J
Description of Work: C S
Historic District: Zoning: Value of Work: S
Permit Type: Building Electrical X_ Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS Addition/Alteration Change of Service
7>(
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:
Q #
of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: ZQ / O 6j g I (Attach Proof of Ownership & Legal Description)
Owners Name & Address: l Ld
Phone:% ,2 r/r Qkro
Contractor Name & Address: GJEC. ie S CJ/`CC .29,SU jX `F ' %//ai 3.,77.5-7
State Lice se Number: 7 !
Q
Phone & Fax: 3S,2-_3 -W 99 Contact Person:` E/C phone7gr,2-_r83-`7 /,P
Bonding Company: Id A4
Address:
Mortgage Lender:
Address:
Architect/Engineer: 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: 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 a licable to this property that may be found in the public records of
this county, and there may be additional permits required from other governmental errtilic5 s Ph as water management districts, state encies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the req ret1o' w,FS7
Signature of Owner/Agent Date Signontractor/ ent Date
E.0
Print Owner/Agent's Name PyATO ontrsw4or/Ageryf s Name f
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg: Zoning:
Initial & Date
Signaturc ofNo tary-Statc`of Florid NTpN Date
t 1Y CC' ;F ;4t I 0 DD 16b491
F.Dru-ryC-5,-:07
i r -- .iax. C
Contractor/Agent is Persynally.KnQwn.toMeo
Produced ID I ) Z)
Initial & Dale)
Special Conditions:
U
a
Utilities: FD:
Initial & Date) (Initial & Date)