HomeMy WebLinkAbout613 Brian Tliff StQ CITY OF SANFORD PERMIT APPLICATION
Permit # : �r ( Date: 17— tom' ✓
Job Address:
Description of Work:
Historic District: Zoning: Value of Work: $
Permit Type: Building Electrical
Electrical: New Service – # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Mechanical Plumbing Fire Sprinkler/Alarm Pool
_ Addition/Alteration Change of ServiceTemporary Pole
Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair – Residential or 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:
(Attach Proof � oTwnersh&
.c. r.
Contractor Name & Address: /j�GyJlq /G% /1-/1 /1 y A 9(11 AKIV -Ir/ifJ a e2
St License Number: AC;74- d5
2242 -!C G
Phone & Fax: =����� Contact Person: �� Phone:Ji�L17
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 sepamte
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 permit is verification that [will notify the owner of the property of the requiremen to ' a ien La FS 713.
Signature of Owner/Agent Date Agnatur f Contract r/Agent Date
PPA ��
Print Owner/Agent's Name Print C tractor/ e
-s
/14
Signature of Notary -State of Florida Date Signatok ' t4gta wfa) n in ate
COMM ission#DD163723
., e= Expires: Dec 20, 2005
?o _ Bonded Wh
Owner/Agent is Personally Known to Me or Contralto{/Wnt i no n to Me or
Produced ID _p ;Produced [D �t%%Zj
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Ronin_:
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)