HomeMy WebLinkAbout213 S Laurel AvePermit #: 0(a - 5c7 e
Job Address:
Description of Work: /C--e— f-0(
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
Date: S W
Value of Work: $ li yUU • V 0
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service— # of AMPS Addition/Alteration 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: (FEb1A form required for other than X)
Parcel #:
Owners Name & Address:
Contractor Name & Address:
Attach Proof of Ownership & Legal Description)
Phone: "0? - 429 -V46 C-
Slate License Number:
Phone & Fax: L() Z i(1* Contact Person: Phone:
Bonding Company:
Address:
Morivaee Lender:
Address:
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 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.
N TI : 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, ar Mere may be a dytiopal permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
of peni it is ve ation I will nol'fy the of the propen`of the requirements of Florida Lien Law, FS 713.
ignatu e f Ow r/Agent
I
arc ( Signature of Contractor/Agent Date
is N me
it of Notof3N Date
MY COMMISSION* DD IW91
EXPIRES: February 25, 2C07
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
O ivnerFAg Ai is ''Persoriall '" n 'wQ jpae or Contractor/Agent is _ Personally Known to Me or
Produced ID Produced ID
APPLICATION APPROVED BY: Bldg: Zoning:
1/64 Utilities: FD:
Initial & Date) (Initial & Dat e
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IY -- (
Initial & Date) (Initial & Dale)
6 Special Conditions: Qh C -44 (MijId ?
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