HomeMy WebLinkAbout800 E Airport Blvd (2)0
3
Permit #: &q
Job Address: 300 F qq ,�✓ lr�
Description of Work: W
Historic District: Zoning:
Permit Type: Building Electrical
Electrical: New Service – # of AMPS
CITY OF SANFOFID PERMIT APPLICATION
Date: �7
—1 % —b3
Mechanical: Residential Non -Residential _
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
Parcel #:
Contractor Name &
Value of Work:
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)
(Attach Proof of Ownership & Legal Description)
State License Number:
Phone & Fax: Contact Person: Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Archltect/Engineer:
Address:
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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: 1 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 's verification that 1 will notify the caner of the property of the requirements of Florida Lien Law, FS 713.
Signature of Owner/Agent Date Signature of Contractor/Agent
Print Owner/Agent's Name Print Contractor/Agent's Name
All
gnature of Notary -State of FI a Date Signature of Notary -State of Florida
Owner/Agent is — Pe ovally Knoto ,S ( T
Produced ID 1=L DU "00, Z ?JO ' V
1�f.
"M-►03APPLICATION APPROVED BY: Bldg:Zoning:
(Initial &'q#) (Initial & Date)
Special Conditions:
Date
Date
Contractor/Agent is _ Personally Known to Me or
Produced ID
Utilities: FD:
(Initial & Date) (Initial & Date)
C.- , 0 ( 0, P. P, f ,