401 W Seminole Blvd Bldg 251 - E08-001648 (meter reset) documentsCITY OF SANFORD PERMIT APPLICATION
Application #'': Submittal Date: +
Job Address: Out t 1 limit agyd —4 91aI Value of Work: $
Parcel ID: Zoning: Historic District:
Description of Work: AeAer Square Footage:
Permit Type: Building Electrical X Mechanical Plumbing 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 # of Water & Sewer Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial Industrial
Construction Type: # of Stories: # of Dwelling Units
of Gas Lines
Plumbing Repair — Residential Commercial
Occupancy Use Group(s):
Flood Zone: (FEMA form required)
Property Owner: } Contractor: [)-s en oandr
Address: 4DJw SPhrllflljr< Bl 1%( Address: ( e
Saun crd
Phone:Q1 LQ, 1051 E-mail: Phone. tate License Number: n
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person
Mortgage Lender:
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 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: 1 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 oft requirements of F orida Lien Law, FS 713.
e of er/Agent Date Signature of n r gent Da e
g nt's Na Print Cont for/Agent's am i
otary,, Late of londa:Date Signature of tary-State of Florida ate
Produced
APPROVALS: ZONING
Special Conditions:
Rev 07.07
TRACY L. RIVERA
W.w.`'"""'-"' wwy ( • Staff N FWW NOTARY PUBLIC - STATE OF FLORIOP,
b aWa 2l, t COMMISSION # DD446184
r %i%o
BBEiPITHRU1-68&NOTA01
Contractor/Agent is Personally Known to Me or
Produced ID
UTIL: FD: ENG: BLDG: