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Carriage Cove lift station
CITY OF SANFORD PERMIT APPLICATION V p0 Application H: � / � Submittal Date: Job Address: L Qo- ©� Parcel ID: Zoning: Historic District: Description of Work: ��Cc= n,Z q r� e o \, Square Footage: ........... ...0000.................... /0000 .....0. 000000000..........0..00.00.. 00000... ......0..00.0.0.............0.. Permit Type: Building ❑ Electrical m Mechanical ❑ Plumb' ❑ Fire Sprinkler /Alarm C1 Pool 13 Sign ❑ Electrical: New Service - # of AMPS — / 06- 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 Plumbing Repair -Residential ❑ Commercial ❑ Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑ Occupancy Use Group(s): Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required) .......................as.0.. .0........0....0..........0.0.0 ...............0.0......_....0 w1............................ Property Owner: i �`� d`t' of n� Contractor: I �,wop,r' V ��- —n r Address: Address: Ave.— OW-4 J 327-4-/ Phone: E -mail: PhA1V73(,-a7V State License Number: Bonding Company: Address: Architect/Engineer: Address: Plan Review Contact Person: Mortgage Lender: Address: 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 applic le 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 w ter management districts, state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the pr f of Florida L• •Law, FS 713. 1) & Signature of Owner /Agent Date Signature o ontractor /Agent l5ate d ��r Print Owner /Agent's Name Print Con ctor /Age 's Name Signature of Notary-State of Florida Date Sign Date ROBERT H. BROWN MY COMMISSION # DD 685352 a` EXPIRES: June 14 2011 Bonded Thru Notary Public Underwriters Owner /Agent is _ Personally Known to Me or Contractor /Agent is _Personally Known to Me or Produced ID Produced ID APPROVALS: ZONING: _ UTIL: FD: ENG: BLDG: Special Conditions: n _ n-r A�