210 S Somerset Ct 04-399 HVACr .,4;
CITY OF SANFORD PERMIT APPLICATION
I
Permit # : Date:
I t ` 3
Job Address: D 6.- cSJ c 1p,._O cl f
i
Ct• W PDQ_Q 1 Description
of Work:i i4") e, .SG Historic
District: -QQ
Zoning:
Value of Work: $ ,q`hq7 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: Mechanical
i Plumbing Fire Sprinkler/Alarm Pool Addition/
Alteration Change of Service Temporary Pole Replacement
New (Duct Layout & Energy Cale. Required) of
Water & Sewer Lines # of Gas Lines Plumbing
Repair - Residential or Commercial Industrial
Total Square Footage: %1./f7 of
Dwelling Units: Flood Zone: (FEMA form required for o0ier than X) Parcel #:
n
i (
Attach Proof of Ownership & Legal Description) Owners
Name & Address: % L C RM9 ej ` cti hJ /Phone:
4D7'
367. % Contractor Nanme &
Address: IJ f Q Ci 7 O6 5 Z-")jyy5Pk am K I ^
7
State License
Number: QI-f 4 Z —mot/ Phone &
Fax: )
4 O 1 aa- y 5s on a on: 0 D Phone: - 3;, Bonding Company:
Address: Mortgage
Lender:
Address: Architect/
Engineer:
Phone: Address: 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. 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. 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 I will notify the owner of the property of the requiremen Flori VXLaw, FS 713. Signature of
Owner/Agent Date Signature of Contractor/Agent Date f FACen, R
0C\ Print
Owner/
Agent's Name me rint Con%ofotMary-State
D k
o av El Gll?
c .` Signature of
Notary -State of Florida Date Signature of Florida D e M o . o Qaad vas
3
tCJ Owner/Agent
is _ Personally Known to Me or Produced ID
Contractor/Agent
is _ Persona Knop tf e o j/ Ql Produced ID
25b i t ON
APPLICATION APPROVED
BY: Bldg: Initial & Date)
Special Conditions:
Zoning: Utilities:
FD: Initial & Date) (
Initial & Date) (Initial & Date)