112 W 17 St - BR08-002442 (ROOF TO TRUSS) (A)RECEIVED
CITY OF SANFORD PERMIT APPLICATION AUGQ
,Application # : Cog 4"T l_ Submittal Date: G 2 1 Z008 1
Job Address: �, w �� t� ST ,AtJ Flb S7 t Value of Work:
Parcel ID: 3 6 d (/ q 30- 506 - Door o ► 8� Zoning: Historic District:
Description of Work; Square Square Footage: .319
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Permit Type: Building Electrical ❑ 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 Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair —Residential ❑ Commercial ❑
Occupancy Type: Residential A Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: FIE' -AMT # of Stories: Z # of Dwelling Units: f Flood Zone: /40 (FEMA form required )
......................•.................................•..............................•.............................•
Property Owner: AE-t-K`.i A • Al2S1wt-JEp() Contractor:
Address: N 2. 1^1 I -7-+K ST Address:
sA,4Fo2n, EL
Phone:+CY7 -3 '?2- 5"_mail: AAA'IZ-iS I; tJ EAV Phone: State License Number:
Bonding Company: N f A EAtzTt-1 L.1W K . N i T Mortgage Lender: NA
Address;
Address:
Arcbitect/Engineer: � Phone:
Address: �} Fax:
Plan Review Contact Person:
A. AIZS� r11~ FAV Phone:�°� ��'� —�Fau? E-mail: AAA25��1/�V
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 COiVI ENCT-MENT.
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 of the requirements of Florida Lien Law, FS 713.
Signature of Owner/Agent Da et Signature of Contractor/Agent Date
JPriAr_se�C_Au
�t:Owncr/A;gen Nam of State of Florida Date
ZpR� %'Uq ROSE HARKFV
* * MY COMMISSION # 565859
EXP RES: J 12, 20
��9TFOFFto`_d.._"1!` Deli �vSJCnown to Me or
PL nee
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
UTIL: FD:
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Contractor/Agent is T Personally Known to Me or
Produced ID
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REVISIDN
PERMIT #05 DATE -
PROJECT ADDRESS
CONTRACTOR o�
PHONE #4-s-�?-'3 KI 5 -7 FAX #
DESCRIPTION OF REVISION
,A D D JD t�- L -S C LX-:
UTILITY DEPT
FIRE PREVENTION
PLANNING
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