HomeMy WebLinkAbout104 Hidden Arbor CtCITY OF SANFORD PERMIT APPLICATION i
Permit # : � � Date: I & ICA
Job Address: ic4- i MD PRe:ole
Description of Work:
Historic District:
G `'
Zoning: Value of Work: $ .51
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:
Total Square Footage:
Flood Zone: (FEMA form required for other than X)
Parcel #: 1 \ • 2 0 "36 - l3 —ppCXS goG (Attach Proof of Ownership & Legal Description)
Owners Name & Address:. 3oLes. --S—cy-sa j 104 t3mi tel- Q �p41�c e 0 3 2113
`1 Phone:
Contractor Name & Address: L -
IA -i:3 Ot > Cj4i ' ' QLk Z�1 State License Number:
Phone & Fax: 40-1'2A) -Z� 4#,Y- Qq -I- Contact Person: Phone: 40l 2d "J Z2y es
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
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. 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 of Flo Lien
+ ` a FS 13. y
s�v \ l 4O (Sri CCI
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg: Zoning:
(Initial &
Special Conditions:
Print Contractor/Agent's Name
ig atu,c.0 &ry- S ta te, orkwrida.lewmanu Date
(Initial & Date)
* * MY COMMISSION M DD 285622
EXPIRES: March 23, 2008
�� e'e 9onded Thru Bu et pot Se I
actor en is _ PersonaKno�vngo hIe or
Produced ID tQ S• 43 • 5421 • S 3 •33 5.0
Utilities:
FD:
(Initial & Date) (Initial & Date)