176 Meadow Blvd 6-1926 FencePermit #: V — l t
Job Address: 1 74 t f
Description of Work: S"1
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
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Date:
Value of Work: $ ?•' 2-04"
APR 0 5 ,
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Permit Type: Building ✓ Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service -- # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. 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 Lone: (FEMA form required for other than X)
Parcel #: 19 yUy (Attach Proof of wnership & Legal Description)
O}x rsName&Address:InPILl,,'IT4]r/ /���%A/]Ai,)'- aAYYt`a h-S<A
Contractor Name & Address: )�L7,t'A
Phone:
License Num
Phone & Fax: =7Lif ` L-/ 5,1 -V L Ism / `�Q%' (y� / �' Etact'Person: il ttku_ f peZ-Ptwne: �1 Z-)
Bonding Company;
Address:
Mortgage Lender: /Kit
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 so t as water nagement districts, state agencies, or federal agencies.
Acceptance of permit is verification that I wilt notify the owner of the property of there, iremen� of F d i [ aw, S 13.
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Signature of-Owner/Agent Date S. fatur o Conu ctor/A [it Date
Print Owner/Agent's Name Print (on[ractr r/Agent's Name ^ LL
Signature of Notary -State of Florida Date / _Signatyre of No ary-State of/ Iorida Date OT
Owner/Agent is — Personally Known to qe or Contractor/Agent is P" ersonally Known to Me or ;
Produced ,V) revy�
— Produced � - --- � q�4yo�y� j
APPLICATION APPROVED BY: Bldg: �Lonin _ h•p4�
Utilities: FD: Mry
(initial & Dail) (Initial & Da el) (Initial & Date) (Initial & Dpi dy '0••••....•.d
Special Conditions:
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PERMIT # 4*
OFFICE
pUtjS REVIEWED
C17Y OF SANFORD