11500 Myrtlewood Dr - M04-002659 (LIFT STATION) DOCUMENTSPermit # :O ~ Q wo
Job Address: //SdO I �I
Description of Work: I V e W L/ t -'T
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
Date: 7 -off 7
Value of Work: $ a
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS /5 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 other than a)
Parcel #: / (Attach Proof of Ownership & Legal Description)
Owners Name & Address: r o !O i G/ �✓O e r i f c s csC / �'� G< -T✓/ rO Avg ✓g
i f 1721 /1 o m /1/0, /0, ,w a / •$ O 3 Phone:
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Contractor Name & Address: I tir bn✓' f fe c 4 y, i C :Vo C
(_ ? ci � CFL � � Oa 3 State License Number: iCC Ott Orpd`-5%
Phone & Fax: ) YC - 77Y-
1000 Contact Person: Phone: 5,q
Bonding Company: gel -k 3g6- 7 7 V- ? Z 2
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Phone:
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 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. 1___)
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applia to this V6aperty that may be found in the public records of
this county, and there may be additional permits required from other governmental entities such a ater maglgement districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the r remk of F da Lien Law, FS 713.
Signature of Owner/Agent
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to a or
_ Produced ID
APPLICATION APPROVED BY: Bldg: Zoning:
('Ini ' Date
Special Conditions:
of Contractor/Agent Date
"Oct A
ontractor gent' a /
Signature 9f Notary -State of Floriqfa Date
r o Kimberly K Lankford
Contractor/Agent is ✓ Personally Kng3v cp11y Commission DD075175
_ Produced ID oro• -Expires November 28, 2005
(Initial & Date)
Utilities:
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(Initial & Date) (Initial & Date)