1708 S Palmetto Ave 04-235 Metal RoofA r--'
Permit # :_
Job Address:
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date: _ c) ' C/W o - c) -"
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Servtce #//o''f AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential _f — Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commer((ctal: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Attach Proof of Ownership & Legal Description)
Phone:
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: Indodition to t uirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of
this county, nV there ma b ditional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Iptance
76
er t is ve I '
hat I will notify the owner of he pro erty of the
C 2 Z
A: S n lure o Owner/Agent Date I\
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a a d
U' IfroSNP
Signature of Notary -State of Florida Oate
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Owner/Agent is P rsgt'y'jj(I Knowp to MMe p/rErsfftZ,7_1.0Produced [D S2
APPLICATION APPROVED BY: Bldg: Zoning:
initial & Dat )
Special Conditions:
of Florida Lien Law, FS 713.
Signature of Notary -State
Contractor/Agent is Personally
Produced ID I& L- c. tl
Utilities: FD:
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e sn%a .Apz 130.2003
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Initial & Date) (Initial & Date) (Initial & Date)