HomeMy WebLinkAbout205 Bradshaw Dr (3)/�( �, � CITI' OF SANFURD PERMIT' APPLICATION {, ` 1
49
V I "0
Permit "�
Job Address: OS / ►q-1�i9h� J 11
Description of Work: 116e ' goo eN Total Square Footage
2 O
Historic District: Zoning: Value of Work: S 2 1 3Ua
Permit Type: Building Ll_�_ Electrical 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 — Residential or Commercial
Occupancy Type: Residential Commercial Industrial
Construction Type: �_ # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required
Owners Name & Address: .J O fin. ' eKS 1 til
Phone: ti 497 - 3� 1— 936 R
Contractor Name &
7490 Vi9i
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: _
Address:
Archilect/Engiacer:
Address:
Contact Person:
License Number: CCC /d9 7'
Phone.
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 requirem of Flori FS 713.
7 06
Signature of Owner/Agent Date Srg ' erre of ntractor/ gent Datc
Print Owner/Agent's Name Print Contractor/Agent's Name
Signature of Notary -State of Florida Date Signature o f Wokiry'-St e F ri a -- Date
DEBBIE BLANTON
ter MMMT
Owner/Agent is _ Personally Known to Me or C nt entti P moup'loagw a or
Produced ID B'25. 2007
Ibsoe, Co.
APPROVALS: ZONING. UTIL: FD: ENG: BLDG:
Special Conditions:
Rev 03/2006