HomeMy WebLinkAbout105 Mapelwood Dr' ,,O j vu CITY OF SANFORD PERMIT APPLICATION
Permit # :—
Job Address:
Description of Work: _y"Lv C -
Historic District: Zoning:
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Date:
?- 6- L7 3
Value of Work: S_ QO. G 0
Permit Type: Building Electrical _.X— Mevbanical _•_ Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service -# of AMPS Addition/Alteration >C Change of Service--- Temporary Pole
Mechanical: Residential',_ Non -Residential __ Replacement New (Duct Layout 8 Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines—_.-- # of Gas Litres
Plumbing/New Residential: # of Water Closets - _ Plumbing Repair - Residential or Commercial
Occupancy Type: Residential _,X_ 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 lame &Address:_8 QY tL Al C 5
�o A V4L V670d n2 --P►.i Fa r4 Phone:_ 323_Zr ✓
Contractor Name & Address: C t a ec frt C geCl W "3T4 5L ) tt/
State License Number: - Oa C.
Phone & Fax: 4(t7-7 - Y? -'Z - _ y 2 _ Contact Person: I�1Jr r k SC 1 V !'„__Phone: 4,o,7-52/- F75?
Bonding Company:
Address:
Mortgage Leader:
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; I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regularng
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 TICS: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that maybe found in the public records of
this county, and there may be additional pen -nits 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 requiremea o ' ALien Law. F$ 713.
Signature of Owner/Agent Date Signarure of Contractor/Agent Date _
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Print Owner/Agent's Name SSS�ignawprcoflsio
nt' Name
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Signature of Notary -State of Florida Date ry-State of Florida D to a y y
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Owner/Agent is _ Personally Known to Me or Cv tractori.4 ent is ersona11 Knnw to Me or 2 e 2
-- Produced ID _—_—__-- Produced ID
APPLICATION APPROVED BY: BWg: Zoning: _ Utilities: FD: _
(Initial &. Dalel (Initial & Dam) (Initial & Date) (initial Jl; Date)
Special Conditions: _ _— -- ---.
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