1200 WP Ball Blvd - M05-003713 (WALKIN COOLER & FREEZER) DOCUMENTSPermit # o s- 37 13
Job Address:
Description of Work:
Historic District:
L.lr.
Zoning:
CITY OF SANFORD PERMIT APPLICATION
Date:
lJ�
LE R +
ALk L n!
Value of Work: $ t(0, 0CY0
Permit Type: Building Electrical chanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non-Residentia 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 Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Contractor Name & Address:�CK J
3S�gl4C.�Q f - 2� rAl l
Phone & Fax: �� — t—z q— Q ! I 6 29
Bonding Company:
Address
Mortgage Lender:
Address:
(Attach Proof of Ownership & Legal Description)
vD CAL440 State
Contact Person:
Phone:
/CV
Architect/Engineer: Phone:
Address: Fax:
[SIL [.fit P—M
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 such as water management districts, state agencies, or federal agencies.
Acceptance of permit is ven cation that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
—(f.D
Signature of ner/Agent Date Signature of Contractor/Agent
n
t O er/Agent's Name
Signature of Notary-Stateyof-Flonda—. "�, e
D 13BIE BLANTON
# DD 198491
Owner/Agent is natty-Known'tQ Me oi-// e(b�ruacy25. 2007
Produced IDa3r' I I 'ia1.;.^. y^Cacoum Assoc. co.
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Zoning:
Contractor/Agent's Name
Date
Signature of Notary -State of Florida Date
Contractor/Agent is _ Personally Known to Me or
Produced 1D
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)