HomeMy WebLinkAbout313 Hidden Lake Dr (3)CITY OF SANFORD PERMIT APPLICATION
Application ft: 0 9� / Submittal Date:
d0
Job Address: _3j,3 ��3Value of Work: $
Parcel ID: I �%' 2U`J`'(�-�0;�'�(,(�ti-��j�UZoning: i�oD�s`toric District:
Description of Work: &J 6 106 f TV7Iti YY1 Square Footage:
..............................................................G........................................................
Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing Er' Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
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 ❑ Commercial ❑
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
............................................,..i../..................................................... .... .. ..
Property Owner: 1 Ph f G� tom- l� Contractor: J • • ... . �1L
Address: 3I 3 17 Address: .3 -% 7 S �,u-e C�
2 763
Phone: -mail: Phone:3'�h%7`f 9 -`(State License Number: GFG0S%_20 j -Sr-
Bonding Company:
Address:
Arch itect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Lender:
Address:
Phone:
Fax:
Phone: Fax:
E-mail:
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 1 will notify the owner of the property of the requirement o Florida Lien w, FS 713. �nf
13 �
1 1
Signature of Owner/Agent Date ig ature of ontractor/Agent Dae}}
Wnl U /�CJU I
Print Owner/Agent's Name Print Cot actor/Agent's Name
�a X�
Signature of Notary -State of Florida Date �JR31 ignature of Notary -State of�lo�da _ Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING: UTIL: FD:
Special Conditions
Rev 02/2007
Contractor/Agent is
Produced ID
ENG:
Notary Public • Slate of Floiide
Commissim E*= Sep 25.2010
Conunlssim 0 DD 50118
WdCd)8Y NAMW Nolan Asan.
BLDG:
IMN
I Vincent Polizzi_hereby authorize
License Holder)
to obtain a gas plumbing permit
(A horized Person)
i tmy behalf under my license # CFC057948
for the job described below
DESCRIPTION
Owner f mit gv-ww�-'
Site Address
Tax Parcel
(License Holder signature)
Date
State of Florida
County ofAALL ((}},,,
Affirmed and subscribed before me this day of_ 20_ byVJ0Y► U I
Who is p -s—onally known t me or has produced (type of ID) as identification
Signature of Notary Public, State of Florida Print, Type or Stamp Name of Notary
?Y a CHRISTINA 0jCAit ENota Pubk • o1 FloridaComrtdsafon ExSep 2S, 2010COMMISIM 0596616Notaries Seal �?t„R '� BDc Neotary Assn
Gas Plumbing Services, Inc.
1377 S. Leavitt Av,-.. Suite# 103 Orange City, FL. 32763 C)OFFICE
Office: (386) 7748244 Fax: (386) 775-1749 State License# CF-C057948 LP# 408-17000
Dater 3- 13
PERMIT NO:��-
BUILDER:
ADDRESS:
MODEL:
GAS TYPE:
DELIVERY PRESSURE: �
PIPE TYPE:
LONGEST RUN:
FURNACE:
RANGE:
WATER HEATER:' 3/4 '
DRYER:
FIREPLACE:
GRILL:
SPA/POOL HEATER
OTHER:
TOTAL LOAD.-
SIZING
OAD:SIZING TABLE USED:
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