HomeMy WebLinkAbout306 Northlake Dr 09-152CITY OF SANFORD PERMIT APPLICATION
Application 0: t — I '7�; a Submittal Date:
Job Address: 3 o T)2.. Value of Work: $ 6 DO. 00
Parcel lD: 1 A - a0 301_5 �q - 0oc)0 - 3U90 Zoning: -I Historic District:
Description of Work: LOo_Tey. V l e_G Square Footage:
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Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing LY Fire Sprinkler /Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service - # of AMPS Additionlgliteration Change of Service ❑ Temporary Pole ❑
Mechanical: Residential A Non - Residential ❑ Replacement ❑ New ❑ (Duct Layout & Energy Cale. 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: # of Stories: # of Dwelling Units: Flood Zone: (F'EMA form required)
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Property Owner: ,C, U U `� Contractor: �' l orl Jo- _De l }a ) %2 e_V)ani caJ
Address: 3V�v N0, n` �e . T-) Address: a9) u br oa_d Waal Cei1 -FCY 81061.
45C f-r %cc6 . EL 3Q113 'Urarvion + FL S35)0'
Phoneii0`l >323 -30T& E -mail: Phone Q;�«-OW State License Number.Cf;f, 1'E Q95)
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Lender:
Address:
Phone: Fax:
Phone:
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 ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicab a 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 management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property'gftre ui m is of Florida Lien Law, FS 713.
Signature of Owner /Agent Date Signature of!Y C-o_� h ntract(or� /Agent Date
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Print Owner /Agent's Name )Print Contractor /Agent's N e I
Signature of Notary-State of Florida Date Signature of Notary-St t of Florida Date
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Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
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Contractor /Agent is '� Personally Known to Me or co
Produced ID
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