HomeMy WebLinkAbout618 E 10 St (3)63-1- 3`-1- PQ�i
Permit # .
Job Address:
Description of Work: t eA.Tro'4?4t.P f�(/
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
Value of Work:
Date: 7 - Z Z- 03
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Construction Type:
Addition/Alteration Change of Service Temporary Pole
_ Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair - Residential or Commercial
Industrial
# of Stories: # of Dwelling Units:
Total Square Footage: '
Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Addr r Jr �G71. t� C�u/t Gri`� �O �8 e /0."( Ir
,.Y #k 'Y]C 44? �r 277/ r Phone: 2;73 — 35 Qf4'
Contractor Name & Address: a A d GI eCT 7 C Z S Z z- So Po -e- k-
,]Qlb j600( FL 7 Z7T3 State License Nu er: 61e 0C'&V 3r1
/
Phone& Fax: 44P7'3?? --1-T&?— F -330-04V Contact Person: �7 /fit 4,eMce Phone:
Bonding Company: i✓lg
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 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 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 govemmental 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 f Florida 'e w,73.
7 3.
-zz�3
Signature of Owner/Agent Date tgnature o Contra /Age Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg: Zoning:
(initial & Date)
Specia! Conditions:
P&;ZAa
ent'ss Name T
,2-07 -0
ignaturc of Notary -State of Flonda Date
Contractor/Agent is _
PrOdUced ID
(Initial & Date)
Utilities:
`�pF rtoN#My
HURLER
A My Comm Exp. Ul/05
ersonall 1e or No. CC 990570
IM smNy rvrown I I Odra LD.
FD:
(Initial & Date) (Initial & Date