1200 Rinehart Rd - BC04-002903 (DUMPSTER ENCLOSURE) DOCUMENTS�j C� CITY OF SANFORD PERMIT APPLICATION
Permit # :d ` l C Date:
Job Address: � a� R4 f\2 K4Rt 9, oap
Description of Work: 1) u Crl n -:--}eC
Historic District: Zoning:
re—
Value
e
Value of Work: S `Fr d 6 G
Permit Type: Building _X_ 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 Zone: (FEMA form required for either than x)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: W f\f C ��� CS �� 'may �J fir, _
Phone:
Contractor Name & Address:
Phone & Fax:/ "
Bonding Company -
Address:
Mortgage Lender:
Address:
l N L State License Number.
Contact Person: 'SOh n 1T) A (,k t 04A Phone:
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 Caws rc:Tdating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT: IN YOU) I`hYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR h.N
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 r mords of
this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptancee permit ' erifi 11 noti owner of the property of the requirements of Florida ie FS 713.
Signa of Owner/ gent„ Date n Signa c Date
_ � � o&_,�.
Print Owner/Agent's Print Contractor/Agent's Name
Signat * tary e of Florida Dat Signature otary-State of Florida Late - -
Owner/Agent is __ Personally Known to Me or
-Produced ID
Contractor/Agent is _ Personally Known to M or
Produced ID _
.OK.
APPLICATION APPROVED BY: Bldg: Zoning: 1103- Utilities: FD:
(Initial & Date) (Initial & ate) (Initial & Date) (Initial & Date)
Special Conditions: