HomeMy WebLinkAbout101 Belvedere WayAi-e,y 76_wn h"o-,w-e-5
RECEIVED
2006
1 ^'
CITY OF SANFORD PERMIT APPLICATION NOV I 0
Permit #V -7 o u ecj er,, Date:
Job Address:
Description of W k: )1 J
Historic District: _ •nR: Value o ,
Permit Type: Building _ Electrical Mechanical Plumbing ' Fire Sprinkler/Alarm Pool G WQ-t
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
r
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 Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: D-r =_ 0 .-- 3 I - 3 /)U n I I — d (Attach Proof of Ownership & Legal Description)
Owners Name & Address: Dv E W*:sT- L L • C 10 1 5t,_iip4 STE 2-Go
kN Z 3Z7S1 Phone: Y07kZ-9L`f_-_.._ - Contractor
Name & Address: em iri a IC cj 1-,,z6 State
License Number: —c-, Phone &
F'az: < < e t' j 47 Contact Person: _(tek- (4,4 di Phone: Bonding
Company: _ Address:
Mortgage
Lender: Address:
Archftect/
tamer). . [ie' i s' -- .l %ri,/vrJ ! y„N J fi Isar Phone: [J. fI - /7 /i/p — - -
Address: ----- -- --- Fax: _'/ U C --- Application
is hereby inade 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 pennit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate pemiit
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 RESUI.T IN YOUR PAYING TWICE
FOR IMPROVEMENT'S TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFOR)i 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 managemeqj,ea ts, state agencies, or federal agencies. Acceptai
per it is rificati t ill tify the owner of th pro rty of the requirements of ten F Signature
of Owner/Agent ate Signature of Contra r/ a Date d.
s Pri
t Ownen gent's n P t ontractor/Agent's N me Sign
ture.of Notary -State of Florida Date Sign re of Notary -State of Flo da aie JESSit ,
NTOA UROKRISTENRODRICKa" Ay PC/'N•. Nora Pun t. `date of Florida teCameraDOOMn ?iP b ; Notary Owner/
Agent is _X Persona Me or W 00 ° Anr ?
9, 20U5 7
Contract et ngw tol ProducedIDBatdedtivu rr `£Pf15 Pro
tl a
u Assn. 4; „Y,` Bon Y APPLICA
LION APPROVED BY: Bldg: •- Zonin /` Utilities: FD: Initial
Date) Initial & ate (Initial & Date) (Initial & Da(c) 1
SpeciifConditions3Q"-Q- D PJ .^ I 1S I Lqa rp 09