HomeMy WebLinkAbout256 Towne Center Cir (3)Permit # : O 3
Job Address:
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Value of Work: $� t
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 # 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 & Address:
Contractor Name & Addr
3/.3S 1r19
Phone & Fax: -2%. g
Address:
Mortgage Lender:
Address:
Architect/Engineer: _
(Attach Proof of Ownership & Legal Description)
Phone:
Bonding Company: '
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.
19
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 1 will notify the owner of the property of the requiremen of Florida tent' FS 713.
Signature of Owner/Agent Date tg ture o Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Print Contractor/Agent's Name
Owner/Agent is _ Personally Known to Me or ContractorlAgent_is
Produced ID �oduced ID
APPLICATION APPROVED BY: BldgfJ22A / ' / Zoning: Utilities:
(Initial & Date) (Initial & Date)
Special Conditions:
to of Floftitda'vte ta. dvrn AQVIDate
* MY COMMISSION # CC 92180E
EXPIRES: March 23. *200A
Bonder' Thru Budget Nolaiy 1_ Ajts
-4z- 3(0J` )
FD:
(Initial & Date) (Initial & Date)
101 1 ' • ` • • '
Date: T lo- t) 3
I hereby a and ia'ppoi�nt/Q,k-Nr' `/ 1 NGt,D i (.(�
Of O / lto be my lawful attorney
in fact to for me and apply to V ki Fat,)/ for
a permit for work to be performed
at a location descn'bed as: Section Townssbip Range
Lot Block Subdivision
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I
o/fJobb,)a ,
7WI) .J�1�J�-I
(Owner cf Property Md Address)
and to sign my namae and do RU things necessary to this appointimeutVWORI—.
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WW—mm= dCertsSed coMaMr)
Acknowledged:
Sworn to and subscaiWd before me this
Day of �L�� A.D. 71�03
Notary Public, State of Florida .............
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(seal)
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My Cammissioa Eapires:�I—n _ = ceoo .324
Commission # 00013407
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FWds Notary Assn.. M