950 S Mellonville Ave 04-1612 Fire supression system,/ L y ,:+CITY OF SANFORD PERMIT APPLICATION
Perrint �`r 1A
Job Address: �� �� - _� Y'���.!�•��
Description of Work:
Date:
Historic District: Zoning: Value of Work: V LI
Permit Type: Building Electrical Mechanical Plumbing . Fr ztett Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service 'temporary Pole
Mechanical-, Residential Non -Residential Replacement New (Duct Layout & Energy Cale. 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 Type: # of Stories; # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: �" 19 ] �� r V'' V1� �° � p A , /� (Attach iPrrgoof of Ownership & Legal Description)
Owners Name &Address: /C) 5� .f I oA NEAITI1 JV1GMf LLC `00 b . A &. ',o • � rJ
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Contractor Name & Address:
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Phone & Fax: HO
Bonding Company:
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Address:
Mortgage Lender: `
Address:
Arc hitect/t, ngineer:
Address:
Contact Person:
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State License Number:
Phone:
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Application is hereby made to obtain a permit to d0 the wojk and instal io c a�indtiyteid I c�tet iSfy that no work or installation has commenced prior to the
issuance of a permit and that all work will be perforated to nee- stitgafds �f alhalvI Ifgul tin cgnstrucnon tq this jurisdiction. I understand that a separate
permit must be secured for ELECTRICAL WORIC;'P[ UIvtBING, SiN�VEL S, 'U� 4WJV3NACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc,
.
OWNER'S AFFIDAVIT I certify that all ofthe Foie1aing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. WARNING TO OWNER: YLOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULTIN 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 oft `?is perm t, thy e may be additional restrictions applicable to this property that may be found in the public records of
this county, and there may be rtAtional *Its re�t edtCr m other governmental entities such as water ntanageen nt districts, state agencies, or federal agencies,
Acceptance of pe%cit is verif 7ti'n th*1viytit ner of t pro. a", of the requirements of Florida [ ien aw, FS 713.
Signatur O. n gout Dat ( Signature of Contracto Aget Date
PrA ens me Pri C p�tractor/Agent's ame r'
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Si gP ¢,. -St Y. a oT mr1cla ate Sign tare ot, oU Sta Ii1$fd"a/i E GRAVE Date
• ': mla�ortEOMMW 16,Zppg * MY COMMISSION # DD 164280
Commission At �D300949 N�°'F �\�� cXPIRFS; No 12, 2006
i.� „�•d• by Nand No foN�n or F Bonded Thru iudget Nola e c ,
0 Cont actor/Agent i Personally Kno�r� i laic or
-__^, Produc_d [D �L_QL. OG'130`AIZN TO f `1 —0 �r ESroduced lD t�(:�JC� C' )\Gl� - `� l(� (> j�
APPLICATION APPROVED BY: Bld � r�7 —tJ -/ L.oning : Utilities:
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(Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
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PUNS REVIEWED
CITY OF SANFORD
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