HomeMy WebLinkAbout3995 St Johns PkwyC!TY OF S.ANFORD PERMIT APPLICATION
Permit # ~ -- Date: --�'�� 3 0 3 _--
Job Address:I��__ofl/t/-�rk
Description of Work; ____ChJ � Y 1/f Cr ✓O/?!Z �.00 kI �,>�_.
Historic District: Zoning: _ Value of Work: ��7 Ot 117
Permit Type: Building Electrical _,_ Mechanical Plumbing Tire Sprinkler/Alarrn ___ Pool
Electrical: New Service -# of AMPS _�- Addition/Alteration --- Change of Service 1)�_ Temporary Pole _
Mechanical: Residential Non -Residential Replacement_ New —_ (Duct Layout & Energy Calc, Regyired)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines _ # of Gas Lines _
PlumbingrNew Residential- # of Water Closets ____ _. __ Plumbing Repair - Residential or Commercial Y
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 #: _ ____.__ __ (Attach Proof of Ownership & Legal Description)
Owners Name & Address:_T)CCZV 0 -riv
Phone: (4 41-7
Contractor Name & Address:t' CV - .,Q,-cTV-tG T _ i�0 i✓ %n '5�r 5AAI rOjW
State License Number: 45 R OOV
Phone & Fax: f„ tOl i Contact Person: at ri �C 11 tJ L z Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
ArchitectlEngineer:
Address:
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that -to 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. 1 understand that a separate
pertnit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS. WELLS, POOLS. FURNACES, BOILERS, IdEATERS, TANKS, and
AIR CONDITIONERS. etc.
OWNER'S AFFIDAVt�f: I certify that ail 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 requirements of F{o'ri iert Law, F i13.
22J,ry3
Signature of Owner/Agent — Date Signature of ContractodAgent Date
(�'?i`CA Ari! 51, Al Vl
Print Owner/Agent's Name
Signature of Nowry-State of Florida Date
Owner/Agent is -. Personally Known to Me or
--- Produced ID
APPLICATION APPROVED BY: Bldg.. Zoning:
(lniti ate)
Special Conditions:
Pr, t Contractor/Agent's e
r ' ar - # DD 164280 Date
EXPIRES: November 12, 2006
�l9TFOF Ft��\oe Bonded Thru Budget Notary Services
Contractor/Agent is Perast>R 11 Known to Me or
Produced IDI
([nidal & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)
01
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