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CITY OF SANFORD PERMIT APPLICATION
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Permit # :D
ate:
Job Address:
Description of Work:
Historic District: v Zoning: Value of Work: S_)
Permit Type: Building Electrical Mechanical V Plumbing Fire Sprinkler/Alarm PoQI- .
Electrical: New Service — # of AJvIPS Addition/Alteration &000e Change of Service Temporl3ry Pole
Mechanical: Residential Non -Residential Replacement New(Duct Layout &Energy Cf Required)
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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 #:
Owners Name &
Contractor Name.,&'Address:
Phone & Fax: JD7-313- 350 Contact Person:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer;
Address:
(Attach Proof of Ownership & Legal Description)
Phone:g*i- 3 01- W6 (IV
State License \u ben: �/QC 0 3 n-
IC,q/ VO Phone:
Phone:
Fax:
Application is hereby trade 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. 1 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 DAPROVEMENTS 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 pemtits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit is verification that 1 will notify the owner of the property of the requirements of Florida Lien G w, FS 713
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Signature of Owner/Agent Date
Signature of Contractor/Agent
Date D N U
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cd oC)
Print Owner/Agent's Name
or•Age Name
W.—
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Signature of Notary -State of Florida Date
ienature of No�ry-State of Florida
X
Date 0— v
Owner/Agent is _ Personalh Known to Me or
Cont.actor/Ag;-: is _ Personaliv Known to Me or
_ Produced ID
Producec' .'D
Al'I'LIC ATION APPROVED BY: Bldg:
I Initial & Dale)
Sp,:ci;,! Conditions:
Zoning:
(Initial &. Datil
(Initial & Dale)
(htitial & Dat;