HomeMy WebLinkAbout125 Pinecrest DrCITY OF SANFORD PERMIT APPLICATION Application #: `�j Submittal Date: d 5/11 Q
Job Address: 125 pinecrest dr Value of Work: $1825.00
Parcel ID: 01-20-30-517-01300-130 Zoning:
Description of Work: Remove obsolete disconnect panel Replace with new disconnect panel
Square Footage:
Historic District:
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Permit Type: Building ❑ Electrical ❑X Mechanical ❑ Plumbing 13 Fire Sprinkler/Alarm ❑ Pool ❑ Sign
Electrical: New Service — # of AMPS 150 Addition/Alteration X❑ 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
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑
Plumbing Repair — Residential ❑ Commercial ❑
Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
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Property Owner: Joann Bumgardner Contractor: Advanced Energy Services Inc
Address: !25 Pinecrest Dr Address: 178 Kenlake Dr Deltona fl 32738
Phone:
Bonding Company:
Address:
Address:
E-mail:
Architect/Engineer:
Plan Review Contact Person:
Phone: 386-804-0853 State License Number: ER0015443
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 I will notify the owner of the property of the requirements,,pi Florida Lien Law FS 713.
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Signature of Owner/Agent Date Signature A Contractor Agent Date
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Print Owner/Agent's Name
Signature of Notary -State of Florida
Owner/Agent is _ Personally Known to Me or
_ Produced ID
APPROVALS: ZONING:
Date
UTIL: FD:
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Si re o Notary -State orida
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Contractor/Agent is _ Perso4y Ktio%Ao Me or y N
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Special Conditions:
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Rev 02/2007
30,60