HomeMy WebLinkAbout298 Seminoble Town Center BlvdPermit # : d - \5b7
Job Address: S1_
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Zoning: Value of Work:
Date: OS 03
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Permit Type: Building Electrical Mechanical Plumbing ✓ Fire Sprinkler/Alarm Pool _
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures )— # of Water & Sewer Lines l # of Gas Lines
Plumbing/New Residential: # of Water Closets —�' Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:y
Construction Type: # of Stories: a- # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address:
l Phone:
Contractor Name &Address: �`rta�� � 1v....�,�..�, cwt c
_ State License Number:
Phone & Fax: �)P% Contact Person:`, 4 �LNP-., Phone: "k%'1 qyh 'ck&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. 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. 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: 1 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
this county, and there gl
Acceptance of permit
Print
of this permit, there may be additional restrictions applicable to this perty that may be found in the public records of
ermits reAd`-ir; om other governmental entities such a?nrstE manag-ekenydtsiRb% state agencies, or federal agencies.
Signature of Notary -State of Florida
owner of the property of the
Owner/Agent is — Personally Known to Me or
Produced I D
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Date
Date
Zoning:
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Signatu a of Contracto Jgen'
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Produced ID
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(Initial & Date)
Utilities:
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(Initial & Date) (Initial & Date)
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Produced ID
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(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)