HomeMy WebLinkAbout300 Northstar Ct (3)Permit # :c\_0 ^ ? q a
CITY OF SANFORD PERMIT APPLICATION
Date:
Job Address: '?� NtKL SMeg= C7—\ fi(At�fF�� (7 L
Description of Work: aty L Ax p Z Ml– (LS , D ISCU�-Ak'C. (S � I,
Historic District: Zoning: Value of Work: $yZoo -o
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
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
_ Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair – Residential or Commercial _
Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description) G
Owners Name & Address: r LL S PSC 1a�� . s -Q I 's ( PO(n Z C:>�
Phone: 4U7- JZ6- % 2-7 5'
Contractor Name &Address: 4L�� Cposzo\,,)� S7, bq"V- L , 33f5 -(k
CP11P r1J ( State License Number: C- 1 '&CSO 17_6 /
Phone & Fax
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Contact Person:
Phone:
Fax:
Phone:
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_ 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: 1 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 requiremen nda Lie S
2 T US
Signature of Owner/Agent Date ature 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:
(in &Date)
Special Conditions:
Pri t Co ra or/Agent's J m�
SignatureofNotgry,Statq-Uolif,NGbR•Lt = Date
MY COMMISSION 4 DD 164280
EXPIRES: November 12,2006
n gCn;Ipd Thr! 19 MCtar.!$E,iH;CE3
Contractor/Agent is Personall Known to M`` e�� or
Produced ID �� O C� 'r
Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date)