HomeMy WebLinkAbout718 Oak Ave.►
CITY OF SANFORD PERMIT APPLICATION p
Permit # : ✓✓✓ Date'
Job Address:
Description of Work:
Historic District: -I&-
MEMORY -1
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
Construction Type: # of Stories:
- A'1'241 Y_el- I-
�—p� Value of Work: S /2�a2 a
V.
Mechanical Plumbing Fire Sprinkler/Alarm Pool
_ 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 Total Square Footage:
_ # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: r--> 4
Phone: -3e0-2' 3 ?C2 " yS_ Z U
Contractor Name & Address: —S
State License Number:
Phone & Fax: Si_ �a�._ Q Contact Person: Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Phone:
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. 1 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 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 requirements of Florida Lien Law, FS 713.
7 %a3
u Owner/Agent Date Signature of Contractor/Agent
Tint Owner/Agent's Name
Mimi-�rTle 9
1. 1 . W 11 ,.VI
i nature hof ot:iry=lit5te ofp�. 41.1, * MY � r�ISSION f CC 9.FXPIPES- March 23r _Cnt is'='='Personally Knowmto Me"of
Produced ID
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Zoning:
Print Contractor/Agent's Name
Date
Signature of Notary -State of Florida Date
Contractor/Agent is _ Personally Known to Me or
Produced ID
Utilities:
FD:
(Initial & Date) (Initial & Date) (Initial & Date)
Address:
CITY OF SANFORD
WRICPRES991r.4TIONBOARD
APPLIC4770N FOR A
SATE OF APPROPRIATENESS
2 Box 1788, Sanford FL 32772-1788
ne: 407 330-5672 Fax: 407 330-5679
Phone Nundmm
Fav[ Hurnber.
Plane "anther:
Fax Hurnber:
Downtown Commercial Historic District: Residential Historic District:
Describe all changes in material, color or location to the exterior of the building and property:
APPIicari's Signature Data
Owners' Signature Dates00'-
OFFIC�AI. USE ONLY
Historic Preservation Board ug Dates �,1t �3 Stab Review Date:
Application is Approved Approved with Conditions
Conditions:
Signed:
Date: "o -"i W
Denied