HomeMy WebLinkAbout2511 Georgia Ave (3)CITY OF SANFORD PERMIT APPLICATION
Permit # :_
Job Address:
Description of Work:4E-4¢42, E- C
Historic District: Zoning:
Date: Z _ 4
Value of Work: $ , i000
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 P Commercial Industrial Total Square Footage: 7 s`
Construction Type: # of Stories: _/ # of Dwelling Units: _/ Flood Zone: (FEMA form required for other than X)
Parcel #: r-Z - Zh - _3C2 --,56y- 0r,2 (Attach Proof of Ownership & Legal Description)
Owners Name & Address::-LAW-WA &fir`- :71A
3 -2- /Q%1 Phone: 6 227 '-7 21-
Contractor Name &
Bonding Company:
Address:
Mortgage Lender:
Address:
ArchitecVEngineer
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. 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.
is verific n that will notify the owner of the property of the requirements of lorida " n La
if Owner/Agent . Date ienat orrtra or/Aeen Date
Tnnt ner/Agent's Name
l+ st
Signature of Notary -State of Florida Date
i
PrOw /Agent is _ Personally Known to Me or
roduced ID TZtL-* yS;tt,-01 7-'7rt-7zo-Ci
TION APPROVED BY: Bldg: 01 jfj QL Zoning:
1 fiat & Date)
Special Conditions:
Signature
if
N tart'
Comractori g l is.
Produced ID _
Utilities:
Initial & Date)
ie ofTFF D-daE BLANTON Date
MY CO:"AISSION # DD 16b491
EXPIREo: February.5, =.07
Rv
Mc
f'L uo:ci 01c: -r..t AZJCC. CO.5Personally Known•to•v
nP i0 / oU
FD:
initial & Date) (Initial & Date)
q3
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company:.o .11YZi, .ram azza
ke address
3 /
azr- 30 phone
Project
Information Permit #:
Subdivision:
Lot
M affiant,
hereby affirm that I am the duly licensed contractor
of record for the above referenced permit, that all the foregoing information is true and
accurate, and that the dry -in, flashings at the above referenced address or lot has been installed
in accordance with the applicable codes and standards. Zsignature
printed
name STATE
OF FLO A COUNTY
OF , / This
instrument was acknowledged before me this j r_ day
of --2 r— , 20p` by the above
referenced individual, - rm r (a ti z-k C,, s , who acknowledged that he/she is a duly
licensed contractor with A SS,- c-- • ea S l— , and who acknowledged that he/
she was authorized to execute this document. He/she is either personally known to me or produced
IFI ; as valid identification. WITNESS
my hand and seal this a:)— day of g-Rb , 20 0,6 C
gelE ynorco.,op/iRs B NTpN J
a• Gt•c QP1F?C-S: F b f Do 1 791 F`
proa7 -s, n_07