HomeMy WebLinkAbout115 Bent Oak Ct (3)Permit #: J � 9
Job Address:
Description of Work: 1_ Y X_-
Historic
CHistoric District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
Date.
> e j --
Value of Work:
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential _
Plumbing/ New Commercial: # of Fixtures i
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential t// Commercial
Addition/Alteration Change of Service Temporary Pole _
_ Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair esidential Commercial _
Industrial Total Square Footage:
Construction Type: �jn# of /SSjtories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: I I/'1 J " ��J^D� D O D lD—/`� ��D (Attach Proof of Ownership & Legal Description)
Owners Name & Address: C Vn 1 , is —0—o /o /
Contracto Name b
f
Phone & Fax!
Bonding Company:
Address:
/7 Contact Person:
State
Phone: ► - 7 lt4l?% j
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address:
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
Signature of Owner/Agent Date Signature of Contractor/
Print Owner/Agent's Name Prim Contra r/Agent's
Signature of Notary -State of Florida Date
Law, F 713 Q
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* MY COMMISSION # DD 164280
EXPIRES: November 12, 2006
�'rorF o' Bonded Thru Budget Notary services
Owner/Agent is _Personally Known to Me or Contractor/Agent is _ Personally Known to Me or
_ Produced ID Produced ID N4,1 C ^ ^1 �� ' a ^ �� -�
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD;
(Initia ate) (Initial & Date) (Initial & Date) (Initial & Date)
Date
Special Conditions: