HomeMy WebLinkAbout207 S Mellonville Ave (2)Permit # : 003—
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Job Address: Z,071 A A e. 110��►
Description of Work:
Historic District: Zoning:
Permit Type: Building _X, Electrical
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets.
CITY OF SANFORD PERMIT APPLICATION
Date: !7 l Z3 16 3
. S --
Value of Wor : S to ot) ., ✓10
Mechanical Plumbing Fire Sprinkler/Alarm Pool
_ Addition/Alteration Change of Service Temporary Pole_
Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair — Residential or Commercial
Occupancy Type: Restdentia X Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel#: 7U' IQ' 30 - SOLI —Q-700
Owners Name & Address:' } \
F L 3 -L-1; I
(Attach Proof of Ownership & Legal Description)
KA" 1pnvttLL A..L Sc&,v-f.,v
Phone: -t 011 - 3 Z ( -
Contractor Name& Address: Yt Of- C.V\P_ l �1av��_y /iC . t4 l0 1 -'"-a AA Ntn-1 L-1 e Lt- L -t e W 3U I
UA Ickr 3'z to State License Number: LL �-
Phone & Fax: 1- V1 0 Contact Person: GC 01l 6i Cr T 1 U -C L -k zA Phone: 3Z I - y '
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 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 p'fmi 's v 'fication that 1 will no a owner of the property of the req rem ts of Florida Lien �
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Signa re of caner/Agent
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Date S" Ru of Contractor/Agent Date
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Print O r/Agent's Name a
Print Co ctor/Agent's Name
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Signature of Notary -State of Florida
Date Signature of Notary -State of Florida Date
0.0'tq* W Amoroso
.M '% W Amoroso
* '"* My commission CC989760
* 'f * My Commission CC989M
Owneh iexpire 6P*25o3" Me or
Contto Me or
_ Produced ID
_ Produced ID
APPLICATION APPROVED BY: Bldg: Zoning:
/�p, • -"'' F �'�' (initial & Date)
Special Conditions:
ter!
Utilities:
FD:
(Initial & Date) (initial & Date) (Initial & Date)