HomeMy WebLinkAbout101 Clear Lake Cir (2)CITY OF SANFORD PERMIT APPLICATION
Date:
Value of Work: s_ k5 -6V . o 0
Permtt.T Ve Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electneal: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential ReplacementNew (Duct Layout &Energy Calc. Reqtured)
Pt_umbing/New.Commercial: # of Fixtttres
# of Water &Sewer Lines_ # of Gas Lines
Plumbtng/New Residential; # of Water Closets _J_ Plumbing Repair — Residential or Commercial
rOccupancy Type: Residential Commercial Industrial Total Square Footage:
,. Construction Type: # of Stories: # of Dwelling Units: Flood Zone:
(FEMA form required for other than X)
Parcel#::tea - -20-_30L- 5 S:T _C)000 - 01?10
44 (Attach Proof of Ownership & Legal Description)
Qwpers;Name & Address:_q t r t z
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Phone:
Contractor_Name,& Address: B Vk'4 �LIIPhR►nl - �f�C ��bt i� P,�t�� _ 2' �C^ ped
.�State License Number.
tE Rbone & Faz "1b��'o?%C!- you 6 ya7-�yr_C T P? Contact Person: r&)2/Y1 i A/`L lL7xt' )fj Phone:
::Bouding Cotgpany. .
Address;
J.
Mortgage Lender:
Address:
Phone:
... tact.
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. [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 AFFID&T: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable taws regulating
construction, and zoning. . WARN ING 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 Ott AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
s -
CE: 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.
r r;.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lie
Signaturo of Owner/Agent Date Signature o ontractor/Agent Date
i x Special Conditions:
(initial & Date)
DEBBIE BLANTON
MY COMMISSION # DD 188491
Utilities:
(Initial & Date)
FD:
(initial & Date)