HomeMy WebLinkAbout130 Sterling Pine StPermit No.: I M
CITY OF SANFORD PERMIT APPLICATION
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Date:-
Job Address o
Permit Type: -'L Building
Description of Work: r1o]
Mechanical Plumbing Fire Alarm/Sprinkler
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Additional Information for Electrical & Plumbing Permits
Electrical: Addition/Alteration _Change of Service I Temporary Pole New AMP Service (# of AMPS )
Plumbing/Residential: Addition/Alteration New Construction (One Closet Plus Additional)
Plumbing/Commercial: Number of Fixtures Number of Water & Sewer Drainage Lines Number of Gas Lines
Occupancy Type:&Residential Commercial _
Type of Construction: Flood Zoi
Parcel No.:
Contact Person:
Title Holder (If other than Owner):
Address:
Bonding Company:
Address:
Total Sq Ftg: value of Work: S
Number of Stories: Number of Dwelling Units:
Attach Proof of Ownershjp & Legal Description)
5Mf T71 State License Number:
Fax Number: y%'33/-076S- V07-331
0'77..
Mortgage Lender: I
Address:
Architect/Engineer Phone No.:
Address: Fax No.:
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.
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Signature of OwnerAgent Date (:;ie of Contractor/ ent toer
l;c;ho ')' — ' /vU a a— ti rm s s Ar- z V a Print
Owner/AgedKs Name Print Contractor/Agent's Name, Owner/
Agent is _ Produced
ID OFFICIAL
SEAL JOHN
W. SPADE, I Notary
Public -Florida C:=
MINOLE COUNTY My
Commission Expires q-/
7-67 -! Ilv
Known to Me or EAL
Dat JoW. SPADE, I -O a- Nota
PubliC-FIorida SEMINOLE
COUNTY My
Commission ELCpires tL -
i Contractor/
Agent is `Personally Known to Me or Produced
ID APPLICATION
APPROVED BY: rnY Date: Special
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COUNTY ROAD 427 SOUTH I
LONGWOOD, FLORIDA 327-A))-.5499 rrkrP"
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