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HomeMy WebLinkAbout105 Hadley DrCITY OF SANFORD PERMIT APPLICATION Application #: � ��•--�� g y Submittal Date: Job Address: ©� Sr¢,Cpf'� C727/'% Value of Work: $ /6zo°O Parcel ID:C060�'�/ `S!9 D - O V 7a Zoning: Historic District: Description of Work: 1A1S7,,9e4_ ZW`6 '1fKL -77,:w (111A.1416 /jl/rfk?t/ V1� 2�quare Footage: _ Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing ❑ 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 Plumbing/New Residential: # of Water Closets Occupancy Type: Residential 19' Commercial ❑ Industrial ❑ # of Gas Lines Plumbing Repair —Residential ❑ Commercial ❑ Occupancy Use Group(s): Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required) •����QC�`n/lt� ............................. Property Owner: E/Contractor Address: 'Ass_/ 401/fes Address: Phone: �Y,383 9782 E-mail: Phone: 47886 State License Number: Bonding Company: Mortgage. Lender: Address: Arch itect/Engineer: Address: Plan Review Contact Person: 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 pe it is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. l�f/ s Signa #6re of Owner/Agent Date Signatu6lof Contractor/Agent Date Print Owner/Agent's Name Print Contractor/Agent's Name Signature of Notary -State of Florida Owner/Agent is _ Personally Known to Me or _ Produced ID APPROVALS: ZONING: Special Conditions: Rev 0212007 Date UTIL: FD: ignature of Notary- tate of, I Date ,f3yDEBB �aNoMy COMIyISS10N pD6290=96 1.R00.3-NOiq[ y S: February 25, 2011 r. tFI. Notary Discount As,oc. Ccl . 3 Contractor/Agent is _ Per nally Known to e o p '' _ Produced ID L /) ENG: BLDG: May.11. 2007 4:01PM 11/2007 Ri 16; i0 FAX 4079437336 Leland I&Welment No. 0631 P. 2 Att~ieimourM nro!iow Bad ) AmUa dad Appitetttiw+: I. ww lv eagement. 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