HomeMy WebLinkAbout1000 Stonebrook Dr (6)'100 1 Cffl' OF SANFORD PERMIT APPLICATION
Permit # :- � —)
Job Address:
Description of Work:
Historic District:
Zoning:
Value of Work: $
Permit Type: Building Electrical _X_ Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service – # of AMPS Addition/Alteration Change of Service Temporary Pole _
Mechanical: Residential 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 – Kcsidcntial or Commercial _
Occupancy Type: Residential _X_ Commercial Industrial
Construction Type: d P '— # of stories: 3 # of Dwelling Units: Flood Zone: (FEMA form required )
Owners Name & Address:
}�
Phone:
Contractor Name & Address: D Le' 2 7t y
• r� p G State License Number: ' G 2
Phone & Fax: go 7 -3 G ! 7 r� 7 9 Contact Person: twsz Phone:.3r�
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
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: 1 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 M 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 requirements of Florida Licn aw, FS 713.
*�- jj�St 6 -I3 ,,L00L*V
Signature of Owns/Agent Date "Signature of C6ntrkl6r1Agcnt Date
L
Print Owner/Agent's Name Vrint ContractodAgenl's Name
w-, (o l 3 p 6
Signature of Notary -State of Florida Date SigAalurc of Notary -State of Florida-/ Date
Owna/Agent is _ Personally Known to Me or
_ Produced ID
APPROVALS: ZONING: UTIL: FD:
Contractor/Agent is Personal y K own to Me or
�Produccd ID C, 2 3 - S 13 b 3► O
ENG:
BLDG: &
Special Conditions: _F0 t,q C I L / %/`STC s 7-2)
Rev 03/2006
POWER OF ATTORNEY '
Date: l3 v1�
I hereby name and appoint ru Q.
ofvV 1kj W -C- to -be my lawful attorney
in fact to act for me and apply to the S
Building Department for a
Leiaa permit
for work to be performed at'a location described as:
Section Township Range Lot
_ Dlock-
Subdivision
/000 - ne.brook hr ' Buu 1 d i' 4�
(Address of ob)
A IMCo PS -a.+{ 1(, / Ste 90P
(owner of Property and Address)SrY; na- -rX -75030
and to sign my name and do all things necessary to this appointment.
r, , , . _
The foregoing instrument was acknowledge before me this —/J3/ -Q6
by
who is �rson�alij�kno�wn�to�/who produced
as identification and who did not take oath.
State of Florida County of
Commission6-
(NotaVy)
My Commission Expires: . W30
1/92
WENDY K JACOBS
* * MY COMMISSION A DD 418964
EXPIRES: June 30,2009
Bonded Thro Budget Nchry services