1210 Tropic Park Dr 09-166CITY OF SANFORD PERMIT APPLICATION
Application #: k_J I - � Submittal Date:
Job Address: Ia O 1 r6 D( G PA r r i Ve, ',50 h d, 9!73 Value of Work: $ (�
Parcel ED:
Zoning:
Historic District:
Description of Work: r-e-L,) i tZ Square Footage:
...... ....................................................................................................................
Permit Type: Building [3 Electrical �j .. Mechanical ❑ Plumbing ❑ Fire Sprinkler /Alarm 13 Pool ❑ Sign E3 Electrical: New Service - # of AMPS // Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non - Residential ❑ Replacement ❑ New ❑ (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential ❑ Commercial ❑
Industrial ❑
Construction Type: # of Stories: # of Dwelling Units:
Plumbing Repair —Residential ❑ Commercial ❑
Occupancy Use Group(s):
Flood Zone: (FEMA form required)
Property Owner: Q-i I- �O[lt'f:5 r =hC . Contractor: El eC4nCa( (_6nce_4 `�` _d,b Qi'�r L _ c
Address: I rook_ Park Drive Address: to 49 N rQ/ VVdy
Sa" -6--d , F I . 3a 77 3 WI n- SA n rla s, 0`4 2a70 k 01, LJ
Phone: �7- 3aa -3,2 -110 E-mail: Phone: : S21 -Lpo5 I State License Number: C R. 1301 SU 9?
I t
Bonding Company: jayr h Qrl �s &nd l og 1O' . Mortgage Lender: 0.
Address: Sr Address:
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 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. 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 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
lS' nature of Owner/A
Name
is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
�ea�P� tll ecd@ Sign a ` Rbbt"191E lon a NOTARY PUBLIC
*s °w OF FLORIDA
®v.Uv GP:'p6i`; :,`C +' °!?iRES 2 -11 -2011
�dae . ® ® C0i'v1ivi1u ;iiN NO. DD638843
T O� er /Agent is rs ally Known to Me or
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
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Date Signature of Contractor /Agent Date
dPrint Contractor /Agent's Name
c{ () !�
.
e Signature of Notary-State of Florida Date
UTIL: FD:
Contractor /Agent is _ Personally Known to Me or
Produced ID
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