HomeMy WebLinkAbout110 Somerset Oaks Ct 03-2877 lights and fan to new addition3 /
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CITY OF SANFOROI" ERMTT APPLICATION
p17 Permit # : — Date:
Job Address: 110 eOm-0 e-+ 6141r5 Cr
Description of Work: —5C iee/V Koe
Historic District: NO Zoning: Value of Work: $
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS -- NO Addition/Alterationy Change of Service Temporary Pole Mechanical:
Residential Non -Residential Plumbing/
New Commercial: # of Fixtures Plumbing/
New Residential: # of Water Closets Occupancy
Type: Residential Commercial Construction
Type: # of Stories: Replacement
New (Duct Layout & Energy Calc.. Required) of
Water & Sewer Lines # of Gas Lines Plumbing
Repair — Residential or Commercial Industrial
Total Square Footage: of
Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: (
Attach Proof of Ownership & Legal Description) Owners
Name & Address: i Gh Ae 114 4 S
9rn Y9S IIVAdye Phone: 46n 3 Z3- 20 74 Contractor
Name & Address:iyF- CLe[Lf' [ TitJC Z5
Z Z. ,,A/
9jell,
1,%el0, C1 S//AV0=apwL'L ? ' Jt
to
License C Number: 4001Z3% Phone& Fax:
f[/7 73 ^! O T Contact Person: cyry Uohslsoou Phone: 4Oi- 3Z Z SiZ Bonding Company:
Address: Mortgage
Lender:
Address: 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 101 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 •'/V, 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. 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 1 will notify the owner of the property of the Signature of
Owner/Agent Date Print Owner/
Agent's Name Signature of
Notary -State of Florida Date Owner/Agent
is Personalh Known to Me or Produced ID
APPLICATION APPROVED
BY: (Bldg: Initial & Date)
Special Conditions:
Zoning: quiremen
fhd
Ljen/aw, FS 7 Ai-patur
ContracfgflAgentPrint Contractor/
Agent' ame Signature of
Notary-S GTAR 'v
Pueuc yo-
ntractor/
Agent is Produced ID
Utilities: Date
My
Comm
Exp. 1/1/05 No. CC
990570 QFeM' .* Known
C I other I.D. FD: initial &
Date) (
Initial & Date) (Initial & Date
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