209 W 1 St - 08-001020 (2008) HOOK UP SINK AND TUBCITY OF SANFORD PERMIT APPLICATION
Application #: 8 — i0po
Job Address:
rr
J7—
Parcel ID: Zoning:
Submittal Date: 2'-2 S oV
Value of Work: S sGo
Historic District:
Description of Work: /yag R a t/ Ole f- -CArk,g Square Footage:
Permit Type: Building Electrical Mechanical Plumbing M( Fire Sprinkler/Alarm Pool Sign
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 Z # of Water & Sewer Lines # of Gas Lines T
Plumbing/New Residential: # of Water Closets Plumbing Repair —Residential Commercial
Occupancy Type: Residential Commercial IX Industrial Occupancy Use Group(s):
Construction Type: # of Stories: / # of Dwelling Units: Flood Zone: (FEMA form required)
Property Owner: THS nrgTFw f13LtTJ* KMP40VContractor: C)¢- V L/ti lf/t f sl•
Address: Address: JrZ y Ci41e?19 n oh/ DA
k r TT" f &RP F"72 -72 77Z
Phone: % 7 i y!o E-mail: Phone: tate License Number: CFCP Z 47Y
Bonding Company: Mortgage Lender:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Address:
Phone: Fax:
Phone:
Fax:
E-mail:
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 ofall 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. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. 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 will notify the owner of the property of he requirements ofFlorida Lien Law, FS 713.
e7 2 / ?
Signature ofOwner/Agent Date Signatur ofContractor/Agent ate
46.-; IJ e:;t evPV
Print Owner/Agent's Name Pr ntractor/Agent's N e
168
Signature of Notary -State of Florida Date Signature of Notary -State of Florida II Iill//
Date
U arJ,V o
Owner/Agent is _ Personally Known to Me or Contractor/Agent is ____r '0 slIy Kkown to Me of .o =_
Produced ID _ Produced ID t- D
APPROVALS: ZONING: V Z'28A UTIL: FD: ENG:
Special Conditions: sw
Rev 07.07 iid111 lll10\1