HomeMy WebLinkAbout174 Pinecrest Dr1,
CITY OF SANFORD PERMIT APPLICATION
Permit # : 7 Date: _
Job Address % 7 1 lP C i A S(J iz _ IYAPM\
Description of Work: ILLa A_rrlwj tlou/11 I Total Square Footage 1 !I v 'V
Historic District: Zoning: Value of Work: S 0 17,0 , 00
Permit Type: Building 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:
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Eagineer:
Address:
Phone:
State Lic se Number:
d
Contact PersonD l7 M Nltk Phom::LJQ77w.3
Phone:
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. 1 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 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 pelmitis verificatiog that *ill notify the owner of the property of the requirements of Florida Lien Law, FS 713.
of Owner/Agent Signature of Contractor/Agent Date
Print Contractor/Agent's Name
of Notary-S a of Florida Date Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
UTIL: FD:
Contractor/Agent is
Produced ID _
ENG:
Personally Known to Me or
BLDG:
Vy3
Company:
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
License #:
Project Information
Owner: boA Aj I-V C ) Aid Permit #:
name
l ut e "KT Q Subdivision: ?(Kp—
address
S AOt26 R- 7-0 Lot #:
phone
1, , affiant, hereby affirm that I am the duly licensed
contractor of record for the above referenced permit, that all the foregoing information is true
and accurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accord a ith the applicable codes and standards.
Contractor: f, /N'
signature y _
printed name
STATE OF FLORIDA
COUNTY OF
This instrument was acknowledged before me this day of , 20 , by the
above referenced individual, , who acknowledged that he/she is a
duly licensed contractor with , and who acknowledged that
he/she was authorized to execute this document. He/she is either personally known to me or
produced as valid identification.
WITNESS my hand and seal this day of , 20
Notary Public