HomeMy WebLinkAbout2102 French AveCrI
Permit # :�./�� Z' I -
Job Address:
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date: k-- C- 0 J _ __
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Zoning: Value of Work: S_OP�,
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS Addition/Alteration Change of Service -9— Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. 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 V_ Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
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Parcel k:/, _ (Attach Proof of Ownership & Legal Description)
Owners Name & Address: R e ti e f -T �iF) a K o WS K -!-
Phone: 4o-7— 32 - 0 770
Contractor Name & Address: QI Gk S a CGTY %7c 9 0 fl W 37tZ Sig A/ 76
/^ State Licerm Number: r2 G V c- 2 r 2 e
Phone & Fax: iif7- �J'L'Z' Io 9 72- Contact Person: I Ck- s414 1 t Phone: Ky7- '3214-733
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 performod 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 IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TOOBI AIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOT&9: 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 requiremen FI ' a Lien Law FS 713.
Signature of Owner/Agent Date ignature of Contractor/Agent Date,
Print Owner/Agent's Name P Name -p
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Signature of Notary -State of Florida Date Signature of Notary -State of Florida a o t' �'
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Owner/Agcni is _ Personally Known to Me orCgptractor/Agent is al Known to Me or o v
Produced ID !`�-Produced ID
APPLICATION APPROVFD BY: Bldg: Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (initial tit Date) (Initial & Date)
Speciol Conditions: _