HomeMy WebLinkAbout106 Drew Ave (3)i' .. .. .. .,. ......:.`1ea3t)i�!�,',V.tk..��r'iS,t"•,. ����.v `i •;••:.rr���yY!;.. .,:ra",;Ad'. a�r.�.. • x ..:--'!JC'c . ��.,
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CITY OF SANFORD PERMIT APPLICATION jti e' ?tn'!! w t Vii:; � .
Permit # V 3' z 3 Date: 61 I �3 J
Job Address:
Description of Work: !Q sn:,�: jcka.f
Historic District: Zoning: Value of Work:
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm PoQI�-. _
Electrical: New Service ZNon-Residential
MPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Replacement New (Duct Layout & Energy Ca1F� Required)
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 Tyne: # of Stories: #. of Dwelling Units: Flood Zone: (FEMA form required £or other than X)
Parcel #: :31— % 9 — 3 % —SZS' OG OD /fd (Attach Proof of Ownership & Legal Description)
Owners Name & Address: t- / % Ii �a Alp eeis
i O (P SA4Jr ten F/ 3 Z 7 7/-39 Whone:32-7- - 997
Contractor Name & Address: < ,% ,ten pde'
20b1 -L0- S�ti�1�o. 4 ' State License Number:
Phone & Fax:40l 'el —"--L -A -4W lk�t —S 1-41 Contact Person: �c�n n�L—Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: 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 )n not tU 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: );r t r.yi.)aring
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUI; I' )h )'01M I'A.YING
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 istricts, state agencies, cn fcdeiA agencies.
Acceptance of permit is verification that I will notify the owner of the property of the re tr mrn of Florid ien
.+ � aTSignature of Owner/Agent Date Signature of if —on ractor/ nt ate
�'1f_L1r� blO/eP_Is
Print Owner/Agent's Name Print Contractor Agent's Name
C
ignature of Notary -State of Honda Date tmattirc 9JiN�sry,;State o6 F `a'u u,4 � to
MY COMIAISS10N # CC VMS
EXPIRES: March 23: ir.)i1�
R gond Tt ru Budget Notary Si -.'urs
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+ Owner/Agentis Persona 11% <no"n to Me or Comm orLAg;r�u _=_ 1•'arponali:'Kiiown li> r t or
Produced ID _ 'roducr.:.D �t—Dl�l � , Stec • k to �S3
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:\I'I'LIC:\TION AI'I'ItUVLU BY: 131dg Zoning:
:Initial & I atC)
Conditions:
(Initial & Dalt)
(Initial K Datc) (It>;twl & Dat:
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