122 W Coleman Cir - M08-001021 (AC SYSTEM) DOCUMENTSF
CITY OF SANFORD PERMIT APPLICATION g
Application # :
1 V I Submittal Date: "/FJ'
Job Address: %- W `-" Value of Work: $ J d u
Parcel ID: 3c7 ` S-b 00r;70 -03 Vb Zoning: Historic District:
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Description of Work.'QC 7494,e 4 SLy Square Footage:
T'.......................................................
Permit Type: Building Electrical MechanicaW Plumbing Fire Sprinkler/Alarm Pool Sign
Electrical- New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: ResidentiaCK Non -Residential ReplacementtV New (Duct Lavoutt& Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial Industrial
Plumbing Repair -Residential Commercial
Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required I
Property Owner: Contractor:
Address:%3.- G/. r$j1t /: Address:
Phorn 7 3;L/-J& mail: Phorr167 9316:,WC 'State License Number:
gBondingCompany: gMort a e Lender: dAr- e / gyri'
Address
Arch itect/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 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. 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 propertv tl uirements of Florida Lien Law, FS 713.
Signature of Owner/Agent Date Signature on ractor/Agent Date
Print Owner/Agent's Name Cintcotractor/
Agent's Name
Signature of Notary -State of Florida Date of Notary State of Florida Date
Opi•PUB! w Donna L. Thomason
Commission # DD604908
Expires November 2, 2010
i Pri 0% o mocl NY Fain iPpwance, ino btlk-50b=701B
Owner/Agent is Personally Known to Me or Contractor/Agent is Personalllynown to Me or Produced
ID Produced ID APPROVALS:
ZONING: Special
Conditions: Rev
07,07 UTIL:
FD: ENG: BLDG: