HomeMy WebLinkAbout147 Country Club DrPermit #:
Job Address: /41 % C,� 2LL1)
Description of Work: n Q,V II,CL (--
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
Value of Work:
Permit Type: Building 4Electrical 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
PlumbinWNew Residential: # of f ter Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than x)
Parcel #:�(Attta'}ch oof of Ow ershf & al✓Description)
Owry`s�s Name& Address:' N , (- , / h
vL %Phone: � D % cV 3
Contractor Name & Address:
State License Number:
Phone & Fax: Contact Person: Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address:
Far:
Application is hereby made to obtain a pexmit 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 besecured 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 M 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 rmit is verification that I ` °t�fy the owner of the property of requirements of Florida Lien Law, FS 713.
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S' ture of Owner/Agent Date Signature of Contractor/Agent Date
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t ner/Agent's Print Contractor/Agent's Name
atureF o *tafy g#I0N f DD 164260 Date Signature of Notary -State of Florida Date
EXPIRES: November 12, 2006
)"'OFF cf?�O~ Bo^4W Thru Budget Notary Services
Owner/Agent is Personally Known to M or Contractor/Agent is _ Personally Known to Me or
_ Produced [D - 1 3s _ Produced [D
APPLICATION APPROVED BY: Bldg.34� 4k Zoning: Utilities: FD:
(Ini a Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
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