HomeMy WebLinkAbout553 Plumosa DrPermit # •
Job Address: J
A
Description of Work:
Historic District: Zoning:
Ae J.
CITY OF SANFORD PERMIT APPLICATION
Date:
of Work: S oZ o O d
Permit Type: Building C/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 Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water sets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone- FEMA form required for other than X)
Parcel #: / / / — S CJ (
Attach Proof of O hi & 1 D ri awnerspLegaenp on)
Owners Name & Ad
S S 3 `z
Contractor Name &
Phone & Fax:
Bonding Company:
Address'
Mortgage Lender: _
Address:
Archltect/Engineer: Phone:
Address: Fax:
Application is herebymade 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 ANiATTORNEYBEFORERECORDINGYOURNOTICEOFCOMMENCEMENT.
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.
Acceptance of permit is verification that 1 will notify the owner of the property of th ments of a*nw, 13.
Signature of Owner/Agent Date Sigpdture of Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida
Owner/Agent is _ Personally Known to Me or
Produced ID
u,
State License Number:
Contact Person: Phone:
Date Signature of.NotarrStdte orFlorida 4TO;Date --
s
DEBEfC- ELF ,st
ey
ContracWr/Age)_ nt i_ Personally, Known to Me or
Produced
APPLICATION APPROVED BY: BI t Zoning:
Initial & Date) (initial & Date)
Special Conditions:
Utilities: FD:
Initial & Date) (Initial & Date)
Nl-
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: _ P'9, License #: C n2- _InP 5 C/a ,/
a
Owner:
o
name 1,7
Project Information
3c-" / I
Permit M
Subdivision:
I Lot M
phone
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.
Contractor.
signature
6 W'Oem'(10.X, elf
printed name
STATE OF FLORIDA
COUNTY OF
This instrument was acknowledged before menec__ day of 206 b theabovereferencedindividuala0LAy , who ackn ledged that he/she is a
duly licensed contractor with , and who acknowledged that
he/she was authorized to execute this document. He/she is either personally known to me or
produced as valid identification_
DEEB'F- BtANTCA
WITNESS my hand and seal this day of i )) MY C-
20.
4 0' 1 , 51
Notary Public