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1408 Oak St 03-1824 HVACPermit # Job Address: Description of Work: iCP,©IQCe— Historic District: Zoning: CITY OF SANFORD PERMIT APPLICATION Date: I I 10. -6 l wo -3 Value of Work: Permit Type: Building Electrical Mechanical __JZ Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service — # of AMPS Addition/Alteration/ Change of Service Temporary Pole Mechanical Residential Non -Residential Replacement V New (Duct Layout & Energy Cale. Required) Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines Plumbinol lew Residential: # of Water Closets Plumbing Repair— Residential or Commercial Occupancy Type: Residential Commercial Industrial Total Square Footage: Construction Type. A # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel A: Owners Name & Address Contractor .Fame & Address: Phone & Fax: `D"i Bonding Company: Address Mortgage Lender: Address: Archirect/Engineer Address: 51'P,11 iK9rS Attach Proof of Ownership & Legal Description) M. ntact Person: Phone: 4L07- `tom o/ se Number: Phone: Fax: o 3aa-7c S 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 permii must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and OR 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 regulanng 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 may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water mans emen trice, state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirement Fl ri e aw, FS 713. Signature of Owner/Agent Date Si nature of Contractor/Agent Date Print Owner/Agent's Name Prilt Can ctor en 's Name Signature of Nowry•State of Florida Owner/Agent is _ Personally Known to Me or Produced ID APPLICA rION APPROVED BY Bldg: Initial & Date) Special Conditions: Date (Signature of Notary -State oP!s S 320 1 ry2Q se`S Contractor/Agent,is,'`` eR$gnall gCtp6ss r Produced I D''. +. °'? 90" Zoning: Utilities: FD: Initial & Date) (Initial & Date) (Initial S Date)