2380 W 25 St - BC08-000772 - BOUNDARY SURVEYApplication #:
Job Address
Parcel ID: AM
CITY OF SANFORD PERMIT APPLICATION
-Submittal Date: v
�� C A .��_ , ��"Vci"li.: it/� Value of Work: $ 5 LID r- iED
I Zoning:
Description of Work: /L��U e l,vL�~ t -!�I\Vn�-1 �K V-4- iy
............................................. .......................
Historic,District: ,..
QC�J('i i2 \�.ikh
Square Footage:
............................................
Permit Type: Building AQ 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 ❑ Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: It of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
•...1 .............• •......................• •..........................►.`....... .... •.. 0 ......................
Property Owner: � rl.411l141, a� f � Contractor: •
\ j �G rS L
Address: , L + /� Addre, : \� , \1 I ,�
Phone: E-mail: Phone:. :A State License Number:
Bonding Company:
Address: -
Address
Mortgage Lender:
Address: 3 to 3rd
Plan Review Contact Person: Phone: Fax:
Phone: )_ � 'Al
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 A'I"TORNEY 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.
Acce t ce of pe it is verification that I will notify the owner of the
10A 1JAAJ
Signature of OwnGLAgen Date
_74MAi R, E& -?,AN )Ak
Print O er/A e 's Name
Signature of Notary-Stateof Florida Date
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+ ��p+;,�� MfCN. WALDEN
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"* Notary PUblio • State of Florida
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. . - iriyy Coiiltitlsllian Expires Jun 18, 2011
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APPROVALS: ZONING: f" ? / 7 UTIL: FD:
Special Conditions:
Rev 07.07
Lien Law, FS 713.
Contractor/Agent is _ Personally Known to Me or
Produced ID
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ENG: BLDG:
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LB # 7442 DATE,
8 S. HWY. 17-92, SUITE 8-A FOR 031,29107
DEBARY, FLORIDA SCALE,
PH. (386) 668-7332 FAX 668-7337 THOMAS CORNWALL PROPERTIES LLC °° _ -/o
COMPUTED BY, DRAWN BY, CHECKED BY, FIELD BY, DATE,
DATE REVISION REVISED BY, CHECKED BY, S. R. B. D. A. P. S' R. h A. _ 02 2> Oi SEMINOLE COUNTY, FLORIDA
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