HomeMy WebLinkAbout2401 Key Ave (3)CITY OF SANFORD PERMIT APPLICATION
Permit # : —( Z "` r
Job Address: ?—go/
Description of Work:
Historic District: Zoning:
Permit Type: Building Electrical
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
G
Value of Work:
Date: rp 94y.fio Total
Square Footage Mechanical
Plumbing Fire Sprinkler/Alarm Pool Addition/
Alteration Change of Service Temporary Pole 40— Replacement
New (Duct Layout & Energy Calc. Required) of
Water & Sewer Lines # of Gas Lines Plumbing
Repair — Residential or Commercial Occupancy
Type: Residential Commercial Industrial Construction
Type: # of Stories: [#1of
Dwelling Units: Flood Zone: (FEMA form required) Owners
Name & Address: l'IQ.L C - /% .z Z A Phone:
Contractor
Name & Address: pd./4/1-f -If/ , GL ff-cf— r — —0' r State
License Number: Phone &
Faz:5Contact Person: ONA 4; XE/;A4CPrPhone: Bonding Company:
Address: Mortgage
Lender:
Address: Architect/
Engineer:
Address: 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. 1 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 apphicWi::to'this properprythat may be found in the public records of this county,
and there may be additional permits requiredfrom other govemrriental entities such as water management districts, state agencies, or federal agencies. w kAcceptanceof
permit is verification that 1 will notify the owner of the property of the require meaWofFloaLien Law, 3. i o Signature
of Owner/
Agent Date Siiiiiature of Co tractoy/Agent Date Print Owner/Agent'
s Name Print Contractor/Agent's Name Signature of Notary -
State of Florida Date i azure of Notary -State o I 'da Date 0;."•0.St
JQ
ANN
K JOHNSON MY COMMiSSION i
DD 285622 EXPIRES: "arch 2
2 Owner/Agent is _
Personally Known to Me or Co `genS' g o to Me or p Produced ID _
roduced
ID C 3 APPROVALS: ZONING: Special
Conditions: Rev
03/2006
UTIL: FD: ENG:
BLDG: