1319 Historic Goldsboro Blvd 09-177Application # : 0
Job Address: /1/9
Parcel ID: .%%,;%% t _W OvOtd -
Description of Work :ddr, =4154
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Permit Type: Building Electrical ❑
Electrical: New Service — # of AMPS
CITY OF SANFORD PERMIT APPLICATION
'�Valuc bmittal Date: 0
2 ,7 of Work:
[� Zoning: Historic District: •�
41 �%!Y1 &AZI/�tf '1 • Square Footage:
if ... ........................— .... Jt I .................... ....................
Mechanical ❑ Plumbing ❑ Fire Sprinkler /Alarm ❑ Pool ❑ Sign ❑
- Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non - Residential ❑ Replacement ❑ New ❑ (Duct Layout & Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑
Plumbing Repair — Residential ❑ Commercial ❑
Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
Property Owner: Contractor: La/1017�/ r 7_]/OY/!QU LWAJI..G/ •G .
Addres C16 U Address: S
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Phone- E -mail: Phone 7State License Number: L
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Bonding Company: � Mortgage Lender:
Address: Address:
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Architect/Engineer:
Address:
Plan Review Contact Person:
Phone: Fax:
Phone:
Fax:
E -mail:
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 al I 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
IMPROVE,NIENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. 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 ofthis 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 verificat' n that I will notify the owner of the propert y f the requirements of F ida ien Law, FS 713.
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ignature of Owner /Agent Date Si lure of ontractor /A ent Date
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Print Owner/ gent's Name Print Contractor /Agent's Name I
o00 Pp,# Notsry State of Florida
Q Ivey Co_,-oission DD714774
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Produced
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
Personally Known to Me or
UTIL:
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