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HomeMy WebLinkAbout910 S Holly AvePermit #: Job Address: Description of Work: Historic District: Zoning: CITY OF SANFORD PERMIT APPLICATION Date: t Value of Work: S®© Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service - # of AMPS Addition/Alteration Change of Service Tempot* Pole Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: # of Fixtures # of Waicr & Sewer Lines # of Gas Lines Plumbing/New Residential: # of Water Closets Plumbing Repair - Residential or Commercial Occupancy Type: Residential /t Commercial Industrial Total Square Footage: Construction Type: #oof%Stories: of%Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel p:1 / lV L l l I _ `/O (Attac(t Progfof Ownership & Legal Description) Owners Name & Address: Contractor Name & Phone Bonding Compan%: Address. Contact Person: Phone: -1f ) !- State License Number: Mortgage Lender: -_ Address: Architect/Engineer: _ 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 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: 1 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 of permit is verification that I sill notify the owna of the propcny of the requirements of a Q O CO rAnfk713. D tNIO Si azure of Owner/A cnl — gn g Date Si azure Contractor/Agent to ` A tj I m I+rc- C NPrintO%%ncr%Agcm'S Name Print mractor/A nt's N e Ea . u rJ ^ S F- 1 Signature of Nolary-Stare of Florida lair ignature of Notary -Stan of Florida D is 0 R 1J .c i),.ncnAgent ,. Pei>unalh Koo,.1::., N1r.,r F- naracloriAgent is - - Personahv Known to Me or Z roo Produced I I) 1'n,duced 11) I'I'! it',•, I ION AI'I'R0\ I:U 11Y. lildg _•__ _ i, . n _ t;uliuc>. _ _•_ 1:1). thNUal \ Date,