HomeMy WebLinkAbout146 Rockhill Dr (3)CITY OFSANFORD PERMIT APPLICATION
Permit it Date: i�,�•� 2 d 0 G
! lob Address:
Description of Work: A d d J (A,C c, -e, r, l 7-C, k,:5 � � (. 5 . ( rA0,1 ' Total Square Footage
Historic District: Zoning; 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
%lechanical: Residential . Non -Residential Replacement New (Duct Layout & Energy Catc. Required)
Plumbing/ New Commercial: # of Fixtures N of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water. Closets Plumbing Repair — Residential or Commercial
Dccupancy Type: Residential Commercial Industrial
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA, form required )
owners Name & Address' d119Z -+ Gt t A 5 [', i^ 0 F T
Phone: - ..
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ontractor Name &Address: A/ %e ��t_ ( \r C 1 Q GT fx [ C At
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State License Number -
°hone & Fax: Contact Person: Phone:
3onding Company:
k \ddress'
(� 4ortgage Lender:
►ddress:
\rchitect/F.ngineer: Phone -
\duress.
E\pplication is hereby made to obtain a permit to do the work and installations as indicated, i certify that no work or installation has conmienced prior to the
ssuance 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
j tomtit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS; HEATERS, TANKS, and
i UR CONDITIONERS, etc-
)WNEP'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
onstruction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
s WICE FOR IMPROVEMENTS TO YOUR PROPERTY: IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
\TTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
j 40TICE: In addition to the requirements of,this pertnit, there may be additionalrestrictions applicable to this property that maybe found in the public records of
his county, and there may be additional permits required from other governmental entities such as water management districts, state'agencies, or federal agencies. .
\cceptanceof permit is verification that I will notify the owner of the property of the requirements of Florida Lien Laws FS 713.
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Signature of Owner/Agent Date /ig.at.,e of Contractor/Agent Date
Print Owner/Agent's Name Print Contractor gent'*s NNaame
Signature of Notary -State of Florida Date Signature LEI9ct51 Date
DEBBIE BLANTON
MY.,COMMISSION # DD 188491
"ra EXPIRES: February25,21m7
Owner/Agent is _ Personally Known to Me or Contracto /AtgNW-I&OTApYPersdikall 6fAi winteshde.oa.
Produced ID Produced "
APPROVALS: ZONING: UTIL- FD:
pecial Conditions:
:ev 03/2006
ENG: BLDG: