HomeMy WebLinkAbout601 Central Park DrCITY OF SANFORD PERMIT APPLICATION
Permit # :_ lJ ! Date: /
Job Address: B/ C•iyTlL6,z %/C ,
Description of Work: gF'Z 46-C-T p, C op L CDLI!e svc h„edD w n r- 5
Historic District: Zoning: Value of Work: S S-mG i
Mechanical: Residential . Non -Residential Replacement New (Duct Layout & Energy Cale. Requited)
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: (FEMA form required for other than X)
Parcel #:
Attach Proof of Ownership & Legal Description)
Owners Name & Address:
S.ss-y%r,+%j f L S2 ^1 / Phone:al 7`Sf gOrofo
Contractor Name & Address: 'p -7 e /e /v tic / ~J 10 e,vl -G $ Toy 4-` ,J--
T 4/i-For2 Rle rS E ' L 3 7-7 State License NumberFe- 'I&V 7-$ % 5—
Phone &Fax: A107 370 /7& 5-- Contact Person: F:'V Phone: Sir--
Bonding Company: /%/
Address:
Mortgage Lender: -
Address:
Architect/Engineer: /lam(/ 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 theissuanceofapermitandthatallworkwillbeperformedtomeetstandardsofalllawsregulatingconstructioninthisjurisdiction. 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.
Acceptance
reqppermitisverificationthat1willnotifytheownerofthepropertyofthe uiremen Florida Lien Law, FS 71
o Ts:
Signature of Owner/Agent Date ignature of Cooatraccttor/Agent Date
Print Owner/Agent's Name ontractor is Name
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Owner/Agent is _ Personally Known to Me or Contractor/Agent is _ Personally Known to Me or
Produced ID _ Produced ID
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions: