HomeMy WebLinkAbout307 E 1 StCITY OF SANFORD PERMIT APPLICATION
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Permit '# : .. \d S Date:
A'aares 3 o? .K•d i 32 77.1 —
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rDescription•of.Work:. _, 6hay p cd -It-Ak FS ZE: tM d- 457441
Historic District: Zoning: Value of Work: S 5-00 , 0 0
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS Addition/Alteration V Change of Service Temporary Pole
Mechanical: Residential Non -Residential _
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
Replacement New (Duct Layout & Energy Calc. Required)
of Water & Sewer Lines # of Gas Lines
Plumbing Repair - Residential or Commercial
Industrial Total Square Footage:
of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel M. (Attach Proof of Ownership & Legal Description)
Owners Name & Address: t*f( 4rA /A S ReL+'/ue v 3 0'% 1 S"d-h Sw^'AWa , AIVYA J".3 277
Phone:
Contractor Name & Address:
State License Number: Gy V V V ,S I V `7 Phone &
Fax: O 1490 G ontact Person: In; kr IeL^4 Phone: 3 2 j ^ 2'3 4 Bonding
Company: Address:
Mortgage
Leader: Address:
Architect/
Eagineer: 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 govemmental entities such as water management districts, state agencies, or federal agencies. Acceptance
of permit is verification that I will notify the owner of the property of the u. is of ri__da Lien -Law, FS 713. Signature
of Owner/Agent Date Signature o'tractor/Agent Date Qqu
L <&^r. &6v Print
Owner/Agent's Name Signature
of Notary -State of Florida Date Owner/
Agent is _ Personally Known to Me or Produced
ID P\
rc* —, APPLICATIONAPPROVEDBY: Bldg: Zoning: Initial &
Special
Conditions: Print
for/Age 's Name LJo
0 4 Signature
of Notary -State of Florida Iate Contractor/
Agent is — Personally Known to Me or Produced
ID Initial &
Date) Utilities: