HomeMy WebLinkAbout613 Sanford AveCITY OF SANFORD PERMIT APPLICATION
Permit # : V & ' 1 ,-xoq v
Job Address:
Date:y2 Z & 0 (o
Description of Work: CWc.k S,r-V C-C— 1`^I T Z L
Historic District: Zoning: Value of Work: $ /,9S - o0 Permit
Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical:
New Service — # of AMPS Mechanical:
Residential Non -Residential Plumbing/
New Commercial: # of Fixtures Plumbing/
New Residential: # of Water Closets _ Occupancy
Type: Residential Commercial Construction
Type: # of Stories: Addition/
Alteration Change of Service Temporary Pole 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 #: / (
Attach Proof of Ownership & Legal Description) Owners
Name & Address: • L't e7 r/es..e %iyfn.v re%.v ;lgcy OSur,l e-,k, Cr/,-- 0 v1a3.1 C /
f Phone:
y c,7 - (l1 L - P41 3 Contractor
Name & Address: ower' S.++urcC, /Ct.4rC 95.Zoc,4,0- 5q- A-)-A5 SS 3a 70
t Stale License Number: C C i 30 O 1 S TO Cr Phone &
Fax:
401 - G -j -0sGt-1 E" Contact Person: y %K 1I<-r' Phone: q07 - (l a7 -04 4 7 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. 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. N TI :
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 I will notify the owner of the property of the require rne s Florida Licn aw, FS 713. Signature of
Owner/Agent Date Signature of Contractor/Agent Date Print Owner/
Agent's Name Signature of
Notary -State of Florida Date Owner/Agent
is _ Personally Known to Me or Produced ID
APPLICATION APPROVED
BY: Bldg: 4fl 04.1 Zoning: Initial &
Date)
Special Conditions:
X, Ma
y -L r— Print tractor/
ent's Name Signature of
Notary-Statrof Florida Date C"` DESME
BLANTON J Lf
tiiYCt: 0*0N# DD'IFiu491 v" E
Contractor/Agent
iis ' '"Personally Known to Mc•ort %wc c Produced ID '
1 6-...,—, Utilities: FD:
Initial & Date) (
Initial & Date) (Initial & Date) P: -, -36