HomeMy WebLinkAbout1809 W 15 St (2)CITY OF SANFORD PERMIT APPLICATION
Permit # : Q� ) g
Job Address:
1909 W I s s/ -
Date:
Description of Work: W t a� N &W He 6+ 10 K"', f- 0,-; Z C'�`
Historic District: Zoning: Value of Work: $ .
Permit Type: Building Electrical "y 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:
Parcel #:
Owners Name &
PV
Addition/Alteration
`J'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)
(Attach Proof of Ownership & Legal Description)
LJ , ( 5- /-A S'f-
J 6M 1-2) 9-t "� I- i �i Phone:
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ContractorName & Address: J O Q ^ �r�o L - �' 2 a'
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4w 7 State License Number:
Phone & Fax: 7 E.3/ 3 she Contact Person:yy 'p—
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address
Fax:
6S
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.
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 will notify the owner of the property of the requireme of Florida Lien Law, FS 713
Signature of Owner/Agent Date nature of Contractor/Agent Date
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Print Owner/Agent's Name P 'nt Contrac r/Age`ns V\ �/ i C5
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Signature of Notary -State of Florida Date natiSflddi9t8ri�a° brs Date
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OEV9100 # NOISSIWW00 AW * �
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Owner/Agent is Personally Known to Me or Contractor/Agent is Personally ICdnown to Me or
Produced ID Produced ID
APPLICATION APPROVED BY: Bldg.Zoning: Utilities: FD:
(Initial ate) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions: