HomeMy WebLinkAbout109 Woodfield Dr (2)CITY OF SANFORD PERMIT APPLICATION
Application 0: %'���� Submittal Date:
Job Address: Value of Work: $ —��9 alb
Parcel ID:%d—�� 5�-565 =OD130 b�%0 Zoning:
Historic District:
Description of Work: -6jl74�HdrLSi7',& Square Footage:0
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Permit Type: Building l3 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: i/ of Fixtures 9 of Water & Sewer Lines
Plumbing/New Residential: 4 of Water Closets
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑
Construction Type: # of Stories: N of Dwelling Units:
# of Gas Lines
Plumbing Repair — Residential ❑ Commercial ❑
Occupancy Use Group(s):
Flood Zone: (FEMA form required
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Property Owner: �F � %%ilj1P/Oz Contractor:.. ` , C- Ccz>k� C dYtS'fk,,c' m, L -t L
Address: Address:dC�'� Sri
Phone: %� 3��i-�%�E-mail: Phone: YD2— 'VIState License Number: a
Bonding Company: )VIA Mortgage Lender:
Address: .Address:
Architect/Engineer: IVI A Phone:
Address: Fax:
Plan Review Contact Person: Phone: Fax: E-mail:
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. 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: 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. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. 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 per it is verification that I will notify the owner of ti roperty of e requirements of Florid a Li Law, FS 713.
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Signature of wner/Agent Date ure of Contractor/.Agent Date
1.1 Y16Z— / O Xq--t_ [7 C CG04_-_
Print Owner/ gent's Nam To r<lctor/,Agent's Name
_/ �J/Q -7
Si nauNg 1 of o n a Date Signature of Notary -State of Flo
.,o.�:•"�. ALD A. FALANGA
oerotere ueerenn
-': 10 ;'_ MY COMMISSION # DD675207
EXPIRES May 16, 2011
Owner/Agent is Personally Known to Me or Contractor/Agent is
Produced ID idL SAL LI C _ Produced ID _
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
UTIL: FD:
ENG:
Notary Public - State of Florida
r Commission Expires Oct 5, 2010
Commission # DD 602840
Through National NotaryAssn.
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