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HomeMy WebLinkAbout206 N Lake Dr1 CITY OF SANFORD PERMIT APPLICATION Permit # : O O Job AddressI bi U I_Ior+ _I_ Description of Work: I l l ita7 ) a-hQ n tf HV Date: � u� Historic District: Zoning: e Value of Work: $ Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole Mechanical: Residential I 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 X) Parcel #: Owners Name & Phone & Fax: Bonding Company: Address: Mortgage Lender: . Address: Architect/Engineer Address: (Attach Proof of Ownership & Legal Description) 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. 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 Date Signature of Contractor/Agent Date A —1 1 , _ — — a . _ i Print Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is _ Personally Known to Me or Produced ID Signature Contractor/Agent is �f _ Produced ID APPLICATION APPROVED BY: Bldg: I Zoning: (In tial & Date) (Initial & Date) Special Conditions: Utilities: v� SCOTT PALMATEER =.. .: MY COMMISSION # DD 395769 R EXPIRES: February 13, 2009 ilA 4 to MVWpru Notary Public Underwriters FD: (Initial & Date) (Initial & Date) 111897 I hereby name and appoint of Date: to - 1 4 ,2 cus to be my lawful attorney in fact to act for me and apply to-�_.,(�i �C(n F� r� for a_ p h `1 n i_ r i permit for work to be performed at a location described as: Section_ Township age Lot Block Subdivision p n o r4 -h [c -d( o b r San- rd -F 1- �z--7 (Acl&m of Job) ©V I n 0 (' .2 O u I oy4h )c , � f turd (Owner of Property and Address) and to sign my name and do all tbwgs necessary to this appointmeat Acknowledged: Sworn to and subscribed before me this I Day of '1 Q ASB. Notary Public, State of Florida (Seal) PON Catherine Ann Coward Commission • My Commission DD16M C My ommisslOIIlI�eS: b, - ,Expires December 28, 2006