401 Plumosa Dr 04-595 HVACPermit #: V
Job Address:
Description of Work:
Historic District:
i c i 7
a
CITY OF SANFORD PERik :APPLICATION zM
Date:
4 M vim.
Zoning: Value of Work:
Permit Type: Building Electrical Mechanicaly Plumbing Fire Sprinkler/Alarm PoQI . Electrical:
New Service — :0
Non-Residenfial f,
A IPS Addition/Alteration Change of Service Tempoeiry Pole _ Mechanical:
Residential Replacement New (Duct Layout & Energy Cal r Required) Plumbing/
New Commercial: # 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
Tyne: # of Stories:. # of Dwelling Units: Flood Zone: (FEMA form required for other eh:an X) Parcel #:
Owners
Name c Address: u
rn- Contractor
Name & Addr s: 9/
5 LJ Phone &
Fax: W)_13}3 Bonding
Company: Address:
Mortgage
Lender: Address-
Architect/
Engineer: Address:
Attach
Proof of Ownership & Legal Descriptioni) Person:
eg l / -L. Phone: 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 commencel 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 applic Alc l.av ,s regulating construction
and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT YK YO UR PAYINI G 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 «rill notify the owner of the property of the requirements of Florida Lien La , FS 71 . o, *.
H0 Signature
of Owner/Agent Date Signature of Contractor/Agent Date a
Print
Owner/Agent's Name Px 0
nn me
Signature of
Notary -State of Florida Date Signature of Notary-Sta e of Florida Date O Owner/
Agent
is _ Personalh Known to Me or Contractor/Ace,.: is _ Personailc Known to Me or Produced ID
Produces :D PPLICA LION
APPROVED BY: Bldg: Zoning: i Initial &
Date) S5CC1;11
Conditions: Ia::..es:
Initial & Date) (
Initial & Date) I`D:
Initial & Dai: